Abstract
BackgroundSocio-economic inequity leads to health inequity. Inequity is closely intertwined with internal migration. This study was planned with the objective of documenting the maternal health care utilization among women labourers working in brick kilns situated in an area of Haryana, north India.MethodsA community based mixed method study was done in select brick kilns of Faridabad district in north India. A mixed method study was done to assess maternal health care utilization in a sample of 500 women in the reproductive age group. Focus group discussions were also carried out. Descriptive analysis was done. Qualitative data was analysed using the thematic framework approach.ResultsThe mean age of the women was 30 (SD 0.3) years. Mean number of pregnancies per woman was 3.1 (SD 1.7). Only 22.9% ever had institutional delivery. About one third of women had ever received cash benefit under Janani SurakshaYojana (JSY) or had ever used free ambulance services. Seven major themes emerged from the qualitative analysis. Important themes include-Gaps in knowledge regarding local health system; Sub-standard private health care delivered at brick kilns prevent migrants from accessing the basic public health services; Misconceptions and mistrust about public health system influenced maternal health care utilization; Barriers to avail universal health coverage: location of brick kilns, time, apathy of public health system, partial health insurance cover.ConclusionsA typical migrant woman labourer in the brick kiln was an illiterate, had migrated from poor states, belonged to a socially disadvantaged community and worked long hours, and had been doing so for many years. This study has identified migrant women working in brick kilns as a vulnerable population subgroup in terms of maternal health utilization. To achieve universal health care it is important to understand the needs of all population subgroups and make concerted efforts at the health system level.
Highlights
One of the most pressing global issues is the growing rates of socio-economic inequity [1]
Seven major themes emerged from the analysis, i.e., 1) Inability to earn livelihood at place of origin; 2) Laborious work in brick kilns often involving pregnant women; 3) Gaps in knowledge regarding local health system; 4) Sub-standard private health care delivered at brick kilns prevent migrants from accessing the basic public health services; 5) Misconceptions and mistrust about public health system influenced maternal health care utilization; 6) Barriers to avail universal health coverage: location of brick kilns, time, apathy of public health system, partial health insurance cover;7) As part of universal health coverage concerted efforts by the public health system to address maternal health needs of migrant women (Table 8)
Our study revealed that a typical migrant woman labourer in brick kiln was an illiterate; primarily worked as an agriculture labourer at her place of origin; had migrated from poor states; she belonged to the socially disadvantaged community and had chosen the present occupation out of indebtedness; she usually worked long hours and had been doing so for many years
Summary
One of the most pressing global issues is the growing rates of socio-economic inequity [1]. According to estimates three out of every ten Indians are migrants [3]. Such migrants mainly work in the informal sector, are responsible for 90% of the workforce and about 50% of the national product [5]. In India, informal sector consists of industries related to construction, agriculture, textiles, brick making, stone quarries and many others [5]. This study was planned with the objective of documenting the maternal health care utilization among women labourers working in brick kilns situated in an area of Haryana, north India
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