Utilization of antenatal care services in a remote, tribal and hilly district of Himachal Pradesh: Challenges to access

Utilization of Antenatal Healthcare Services, Associated Factors, and Pregnancy Outcomes Among Postnatal Women Who Delivered in Selected Rural Healthcare Centers in Odisha, Southeastern India

BACKGROUND

 Adverse pregnancy outcomes remain a prevalent health issue in India. Many of the negative consequences could be avoided if mothers used prenatal care. However, in many low-resource Indian situations, the use of this service and its drivers has not been thoroughly studied. Therefore, this study was conducted to assess the utilization of antenatal care (ANC) services and the various factors affecting this utilization and pregnancy outcomes.

MATERIAL AND METHODS

 A cohort study was conducted among 326 recently delivered mothers in Khordha District, Odisha, in the southeastern community of India. A multistage sampling technique was used to select the desired sample. Demographic variables were obtained through a structured demographic proforma; maternal knowledge was evaluated using a structured knowledge questionnaire; and a factor-related structured questionnaire was used to identify factors associated with ANC service utilization. An interview method was used to collect the information from the participants. The data were entered using EpiData version 1.4.4.0 (Buenos Aires, Argentina) and exported to IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York) for analysis. Bivariate and multiple logistic regressions were applied to identify participants and predictor variables, respectively.

RESULTS

This study revealed that 227 (69.6%) had attended four or more recommended antenatal visits. The main perceived barriers to ANC access were unplanned pregnancy, delay in pregnancy confirmation, uncooperative partner, lack of family support, and distance from the health facility. It was found that 287 (88.1%) of women had adequate knowledge about the danger signs of pregnancy, and 174 (53.4%) were aware of available ANC health services in their locality. Knowledge of women was revealed to be a major factor impacting the utilization of ANC health services in this study (crude odds ratio (cOR) 24.03; 95%CI 12.37-46.65; p<0.01). It is also found that poor antenatal utilization was associated with an increased likelihood of complications arising during the antenatal period (cOR 2.43; 95%CI 0.34-18.71, p=0.01), immediate postnatal complications (cOR 1.77; 95%CI 2.43 0.83-17.15; p=0.02), cesarean section and operative vaginal delivery rate (cOR 1.88; 95%CI 1.11-3.17; p=0.03), and post-term babies (cOR 5.64; 95% CI 1.31-24.4; p=0.01).

CONCLUSION

The utilization of WHO-recommended ANC service in the present study area was found to be poor. The quality of ANC and maternal awareness among the population were found to be the factors that influence women's good utilization of ANC. Underutilization of ANC health services had a significant impact on adverse pregnancy outcomes, such as complications that arise during the antenatal and immediate postnatal period, cesarean sections, and operative vaginal delivery rates, as well as post-term pregnancy. These results can be utilized to develop a health intervention program to enhance maternal health utilization practices and, ultimately, improve maternal and child health quality in low-resource settings in India.

Barriers in utilization and provisioning of obstetric care services (OCS) in India: a mixed-methods systematic review

BACKGROUND

Despite the reduction in the maternal mortality ratio, barriers in obstetric care services (OCS) remain a significant risk factor for adverse maternal and perinatal outcomes in India. This review covers the 'continuum of care' (ANC, child delivery, and PNC services) and identifies multiple barriers in provisioning as well as utilization of OCS in India. We conducted a systematic review to understand the barriers using a mixed-methods approach.

METHODS

PubMed, Scopus, Web of Science, Google Scholar, and Science Direct databases were searched from 1 January 2000 to 30 June 2022. The methodological quality of the included studies was assessed using appropriate tools. After a full-text review of 164 studies, total of 56 studies (33 quantitative, 18 qualitative, and 5 mixed-methods studies) were finally included in the review. All the barriers were classified into five major themes: (i) individual and interpersonal barriers, (ii) social and cultural barriers, (iii) structural barriers, (iv) logistical barriers, and (v) organizational barriers. A thematic synthesis approach was used to present the findings of the included studies.

RESULTS

Lack of knowledge and awareness and less family support in availing the required OCS were key individual and interpersonal barriers. Negative social and cultural practices, such as belief in traditional herbs/healers, dietary restrictions, and discarding colostrum were frequently reported barriers, especially in rural settings. Poor economic status and high health service costs were the most often cited barriers to low institutional delivery and delayed ANC services. Long distances to health facilities and poor road conditions were the most frequently reported logistical barriers. On the provisioning side, poor quality of treatment, shortage of drugs and equipment, and non-cooperative attitude of health professionals were the most significant barriers.

CONCLUSION

This review identified several important barriers ranging from individual and cultural to structural, logistical, and organizational, which are prevalent in India. To mitigate the barriers, the governments need to develop strategies at the individual and organizational levels. Innovative interventions and program implementation at the community and village levels could also be contributory steps towards improving OCS utilization in India.