IJCM_20A: Understanding determinants of increased home deliveries in accessing antenatal care in the two blocks of the Chamba, Himachal Pradesh

Abstract

Background: Maternal mortality has been declining over the years in India. Despite India achieving a maternal mortality ratio below 100 per 100,000 live births by 2020, Chamba, an aspirational district of Himachal Pradesh, still faces challenges. In Chamba, access to antenatal care (ANC) and postnatal care (PNC) remains suboptimal. Objective: To understand the perspectives of key stakeholders on barriers and facilitators for accessing ANC/PNC and institutional delivery services in the Chamba district. Methodology: The qualitative study was conducted in May and June 2023 in two blocks of the Chamba district. Around 5-6 villages were purposively selected in each block. The study encompassed 19 in-depth interviews and 7 focus group discussions involving lactating and pregnant women, family members, medical officers, and frontline healthcare workers. Additionally, the assessment of 2 labour rooms at the health facility was conducted using DAKSHATA standards. Results: The study revealed multifaceted barriers in Chamba, including challenging road conditions worsened by weather impeding timely health facility access. Women’s heavy workloads and limited awareness resulted in delayed ANC, PNC, and registration. Cultural preferences and myths hindered institutional deliveries. Transportation challenges, ambulance limitations, hospital overload, and health facility constraints amplified the difficulties. The DAKSHATA assessment indicated a mean score of 22 out of 30, stressing the need for improvements to enhance ANC, PNC, and institutional delivery access. Conclusion: The findings emphasize the critical need for interventions that enhance awareness among women, counteract cultural preferences for home deliveries and dispel prevalent myths and misconceptions. Furthermore, addressing transportation limitations, ambulance constraints, and hospital overload is crucial.