Abstract
BackgroundKarnataka 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.MethodsThis 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.ResultsMost 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 women’s 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.ConclusionsRural 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 registrationNCT01911494Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0138-8) contains supplementary material, which is available to authorized users.
Highlights
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
Much of the progress made has been attributed to the National Rural Health Mission (NRHM) that has increased the number of community health workers and community level facilities, and resulted in more institutional deliveries [1, 2]
Identification of pregnancies may be limited by availability of pregnancy tests: “Many times Auxiliary Nurse Midwives (ANM) or Accredited Social Health Activists (ASHA) do not have a free supply of pregnancy kits” [ANM/staff nurse]
Summary
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. Much of the progress made has been attributed to the National Rural Health Mission (NRHM) that has increased the number of community health workers and community level facilities, and resulted in more institutional deliveries [1, 2] (see Table 1) These community health workers (Accredited Social Health Activists, Auxiliary Nurse Midwives, Anganawadi worker, staff nurses) provide routine antenatal care in the home or government run centres (sub-centre, primary health centre, community health centre). The timing and frequency of visits in pregnancy and postpartum is not well known, there is a paucity in the literature regarding the indications for which women and families feel necessary to seek care and the cultural beliefs guiding these decisions Rural areas, such as the study areas of Belgaum and Bagalkot, have poorer coverage and access to maternal health care services and deserve targeted review
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