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Despite vast economic growth in developing countries in the past few years, infant mortality continues to plague underdeveloped regions, particularly rural regions of India. Many of these deaths are caused by a lack of education and motivation in regard to utilization of antenatal and neonatal care services to prevent and treat consequences of unhygienic umbilical cord care.

For years, high incidences of neonatal tetanus have plagued rural areas of India as a result of cultural practices that encourage topical applications of cow dung to cut umbilical stumps either directly or by using ghee heated with cow dung to warm umbilical dressings. In order to increase public awareness of the practical ineffectiveness of tetanus toxoid vaccinations in treating the consequences of unhygienic umbilical cord care, cultural aspects that contribute to mothers’ utilization of antenatal care services in rural India should be identified in order to understand sociological factors that affect neonatal mortality rates in rural India so that intervention efforts may be targeted appropriately to effectively eradicate neonatal tetanus. A variety of sociology and public health articles and journals that outline factors deeply engrained in Indian culture that inhibit mothers from accessing health care services hypothesize why legislations that promote availability of vaccines have proved rather ineffective in reducing mortality rates were reviewed. These sources generally attribute lack of utilization of health care services to predisposing variables (such as age, ethnicity, caste, education level, and occupation), enabling variations (distance to health facility, means of transport), and a lack of perceived need of care.

An analysis of the reasons behind hesitation and reluctance to use antenatal and neonatal care services can help target intervention efforts to appropriately reach at-risk demographic groups. While immunization is understood as effective in treating the immediate effects of unhygienic umbilical cord care, education of young, uneducated and unemployed, lower caste, Hindu women before they get pregnant can encourage use of available health care resources. It is only by understanding embedded cultural factors that policies can be constructed to effectively reduce maternal and neonatal mortality rates in rural India.

Publication Date


Subject Major(s)

Public Health


public health, neonatal tetanus, India, utilization, antenatal care services


International Public Health | Maternal and Child Health | Medical Humanities | Public Health Education and Promotion | Social and Cultural Anthropology | Women's Health

Current Academic Year


Faculty Advisor/Mentor

Mary Boyes


© The Author(s)

Cultural Factors Associated with Utilization of Antenatal Care Services in Rural India