Utilization of maternal health care services and their determinants in Karnataka State, India

Monday, 11th of July 2016

Reprod Health. 2016 Jun 8;13 Suppl 1:37. doi: 10.1186/s12978-016-0138-8.

Utilization of maternal health care services and their determinants in Karnataka State, India

Vidler M¹, Ramadurg U², Charantimath U³, Katageri G⁴, Karadiguddi C³, Sawchuck D⁵, Qureshi R⁶, Dharamsi S⁷, Joshi A³, von Dadelszen P⁵, Derman R⁸,Bellad M³, Goudar S³, Mallapur A⁴; Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group.

Author information

¹Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada. Marianne.vidler@cw.bc.ca.
²Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka, India.
³KLE Universitys Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
⁴Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India.
⁵Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada.
⁶Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan.
⁷Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁸Department of Obstetrics, Christiana Care, Newark, DE, USA.

Abstract below; full text is at http://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-016-0138-8

BACKGROUND:

Karnataka State continues to have the highest rates of maternal mortality in south India at 144/100,000 live births, but lower than the national estimates of 190-220/100,000 live births. Various barriers exist to timely and appropriate utilization of services during pregnancy, childbirth and postpartum. This study aimed to describe the patterns and determinants of routine and emergency maternal health care utilization in rural Karnataka State, India.

METHODS:

This study was conducted in Karnataka in 2012-2013. Purposive sampling was used to convene twenty three focus groups and twelve individual interviews with community and health system representatives: Auxiliary Nurse Midwives and Staff Nurses, Accredited Social Health Activists, community leaders, male decision-makers, female decision-makers, women of reproductive age, medical officers, private health care providers, senior health administrators, District health officers, and obstetricians. Local researchers familiar with the setting and language conducted all focus groups and interviews, these researchers were not known to community participants. All discussions were audio recorded, transcribed, and translated to English for analysis. A thematic analysis approach was taken utilizing an a priori thematic framework as well as inductive identification of themes.

RESULTS:

Most women in the focus groups reported regular antenatal care attendance, for an average of four visits, and more often for high-risk pregnancies. Antenatal care was typically delivered at the periphery by non-specialised providers. Participants reported that sought was care women experienced danger signs of complications. Postpartum care was reportedly rare, and mainly sought for the purpose of neonatal care. Factors that influenced womens care-seeking included their limited autonomy, poor access to and funding for transport for non-emergent conditions, perceived poor quality of health care facilities, and the costs of care.

CONCLUSIONS:

Rural south Indian communities reported regular use of health care services during pregnancy and for delivery. Uptake of maternity care services was attributed to new government programmes and increased availability of maternity services; nevertheless, some women delayed disclosure of pregnancy and first antenatal visit. Community-based initiatives should be enhanced to encourage early disclosure of pregnancies and to provide the community information regarding the importance of facility-based care. Health facility infrastructure in rural Karnataka should also be enhanced to ensure a consistent power supply and improved cleanliness on the wards.

TRIAL REGISTRATION:

NCT01911494.