TY - JOUR
T1 - Utilization of maternal health care services and their determinants in Karnataka State, India
AU - Vidler, Marianne
AU - Ramadurg, Umesh
AU - Charantimath, Umesh
AU - Katageri, Geetanjali
AU - Karadiguddi, Chandrashekhar
AU - Sawchuck, Diane
AU - Qureshi, Rahat
AU - Dharamsi, Shafik
AU - Joshi, Anjali
AU - Von Dadelszen, Peter
AU - Derman, Richard
AU - Bellad, Mrutyunjaya
AU - Goudar, Shivaprasad
AU - Mallapur, Ashalata
N1 - Funding Information:
This work is part of the University of British Columbia PRE-EMPT (Pre-eclampsia/ Eclampsia, Monitoring, Prevention and Treatment) initiative supported by the Bill & Melinda Gates Foundation. We gratefully acknowledge contributions of the Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group: Shashidhar Bannale, Beth Payne, Zulfiqar Bhutta, Laura Magee, Chirag Kariya, Sharla Drebit, Sheela Naik, Sangmesh Rakkareddi, and Amit Revankar. We also acknowledge the support of KLE University, JN Medical College, SN Medical College, University of British Columbia, Government of Karnataka, the district health administration of Belgaum and Bagalkot Districts, the local medical officers, staff nurses, auxiliary nurse midwives, accredited social health activists, and other health centre staff and community leaders for their participation and their efforts in motivating community participation. We thank the research office staff for assisting in data translation and transcription. Finally, a special thanks to all the focus group and interview participants.
Publisher Copyright:
© 2016 Vidler et al.
PY - 2016/6/8
Y1 - 2016/6/8
N2 - 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 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. 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.
AB - 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 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. 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.
KW - Focus groups
KW - High risk
KW - Hypertension
KW - India
KW - Maternal Health Care Utilization
KW - Maternal Health Services
KW - Postnatal care
KW - Pregnancy
KW - Pregnancy
KW - Prenatal care
KW - Qualitative methods
KW - Rural population
UR - http://www.scopus.com/inward/record.url?scp=84973375524&partnerID=8YFLogxK
U2 - 10.1186/s12978-016-0138-8
DO - 10.1186/s12978-016-0138-8
M3 - Article
C2 - 27356502
AN - SCOPUS:84973375524
SN - 1742-4755
VL - 13
JO - Reproductive Health
JF - Reproductive Health
IS - 1
M1 - 37
ER -