Utilization of maternal health services and determinants of skilled care during delivery in slums of Gujarat, India

Abstract

Background: In India one in three women is delivering without skilled care. This is happening even after the Safe Motherhood Initiative began two decades ago. Aim & Objective: The aim of the present paper is to assess utilization of maternal health services and factors affecting skilled delivery care among urban slum women. Method: We selected 562 women delivered two year prior to survey using two stage clusters sampling for a community based cross sectional study. Using a pre-tested structured interview schedule, information was collected on demographics, socioeconomic status, use of maternal health services, and reasons for non-utilization of health services. Univariate and multivariate analysis were performed. Result: Majority (92%) of women received at least one antenatal care during pregnancy, while only 4 out of five women sought skilled care during the last delivery. Women of educationally and socially backward classes (OR=0.46, 95% CI 0.230.94), women live in a distance more than two kilometers from maternity health facility (OR=0.38, 95% CI 0.22-0.65), and women been on their second pregnancy (OR=0.44, 95% CI 0.21-0.94) utilized less of skilled care during delivery compared to their counterparts. Increase in education level of women and number of Antenatal care received were tending more utilization of skilled care during delivery. Minimal sense of need, cost, social barriers and perceptions about care were found to be the reasons for not seeking care. P oor attitude of providers, poor quality of services and long waiting time were found to be the reasons for non-utilization of public health facilities. Conclusion: The factors determine skilled delivery care were caste affiliation, education, service availability, parity, perceived utility of services and health seeking behaviors. Government institutions were lying underutilized as women do not prefer them for delivery.