BMC Pregnancy and Childbirth
Volume 15, Issue 1, 2015

Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: A mixed methods study (Article) (Open Access)

Alcock G.* , Das S. , More N.S. , Hate K. , More S. , Pantvaidya S. , Osrin D. , Houweling T.A.J.
  • a Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, United Kingdom
  • b Society for Nutrition, Education and Health Action (SNEHA), Urban Health Center, 310, 3rd Floor, 60 Feet Road, Dharavi, Mumbai, 400 017, India
  • c Society for Nutrition, Education and Health Action (SNEHA), Urban Health Center, 310, 3rd Floor, 60 Feet Road, Dharavi, Mumbai, 400 017, India
  • d Society for Nutrition, Education and Health Action (SNEHA), Urban Health Center, 310, 3rd Floor, 60 Feet Road, Dharavi, Mumbai, 400 017, India
  • e Society for Nutrition, Education and Health Action (SNEHA), Urban Health Center, 310, 3rd Floor, 60 Feet Road, Dharavi, Mumbai, 400 017, India
  • f Society for Nutrition, Education and Health Action (SNEHA), Urban Health Center, 310, 3rd Floor, 60 Feet Road, Dharavi, Mumbai, 400 017, India
  • g Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, United Kingdom
  • h Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, United Kingdom, Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA 3000, Netherlands

Abstract

Background: Discussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the determinants and choice of maternity care provider in Mumbai's informal urban settlements, and to explore the reasons underlying their choices. Methods: The study was conducted in informal urban communities in eastern Mumbai. We developed regression models using data from a census of married women aged 15-49 to test for associations between maternal characteristics and uptake of care and choice of provider. We then conducted seven focus group discussions and 16 in-depth interviews with purposively selected participants, and used grounded theory methods to examine the reasons for their choices. Results: Three thousand eight hundred forty-eight women who had given birth in the preceding 2 years were interviewed in the census. The odds of institutional prenatal and delivery care increased with education, economic status, and duration of residence in Mumbai, and decreased with parity. Tertiary public hospitals were the commonest site of care, but there was a preference for private hospitals with increasing socio-economic status. Women were more likely to use tertiary public hospitals for delivery if they had fewer children and were Hindu. The odds of delivery in the private sector increased with maternal education, wealth, age, recent arrival in Mumbai, and Muslim faith. Four processes were identified in choosing a health care provider: exploring the options, defining a sphere of access, negotiating autonomy, and protective reasoning. Women seeking a positive health experience and outcome adopted strategies to select the best or most suitable, accessible provider. Conclusions: In Mumbai's informal settlements, institutional maternity care is the norm, except among recent migrants. Poor perceptions of primary public health facilities often cause residents to bypass them in favour of tertiary hospitals or private sector facilities. Families follow a complex selection process, mediated by their ability to mobilise economic and social resources, and a concern for positive experiences of health care and outcomes. Health managers must ensure quality services, a functioning regulatory mechanism, and monitoring of provider behaviour. © 2015 Alcock et al.

Author Keywords

health inequalities maternal health Health care utilisation India Determinants of care Urban slums

Index Keywords

Vulnerable Populations vulnerable population urban population maternal care urban area educational status regression analysis prenatal care India poverty health care personnel human middle aged statistics and numerical data health service controlled study interview Young Adult social status Humans psychology Adolescent private hospital female Socioeconomic Factors socioeconomics tertiary care center pregnancy Tertiary Care Centers public hospital Article delivery obstetric delivery organization and management adult grounded theory health education health care access age regulatory mechanism Age Factors Poverty Areas utilization Choice Behavior parity health care facility maternal health service Maternal Health Services decision making Delivery, Obstetric Hospitals, Private Healthcare Disparities health care disparity Health Services Accessibility health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84942566081&doi=10.1186%2fs12884-015-0661-6&partnerID=40&md5=6a4f0fbfd50984507bf7e4279f81a01b
DOI: 10.1186/s12884-015-0661-6
ISSN: 14712393
Cited by: 6
Original Language: English