Maternal health care utilisation among the urban poor of Maharashtra, India

Abstract

Previous studies have shown that the uptake of maternal health care in developing countries has significant consequences for the state transition of the mother through pregnancy and childbirth (Khan 1987). The Indian National Family Health Survey (1992/93) shows that the utilisation of pre-natal care in India is low at only 63% and that the care received is often characterised by an insufficient number of visits timed late into the pregnancy. Furthermore, the delivery care utilised in India is dominated by home births, often performed by untrained local midwives.India contains a significant proportion of the world's births, and like other developing countries, has experienced a rapid growth in its urban population, and a subsequent increase in the numbers of urban poor. Maharashtra in particular, which contains the megacity of Mumbai (formerly Bombay) and the Pune-Thane-Nagpur belt has rapidly developing urban populations and the commensurate diversities of morbidity, mortality and service use. Women living in poorer areas of Maharashtra's urban settlements often have a choice of maternal and child health services that are not available to their rural counterparts.This thesis examines the patterns and prevalence of maternal health care utilisation among the urban poor, and explores the range of motivational factors behind the decision to uptake antenatal care and deliver a child in a formal medical institution. Factors influencing health care utilisation are multifaceted. Therefore, a combination of quantitative and qualitative methodologies are employed. The Indian National Family Health Survey of Maharashtra (1992) is used to examined the timing of the first antenatal visit, the number of visits made and the place of delivery. Multinomial regression analyses are applied to the data to identify socioeconomic and demographic determinants of maternal health care use. A composite index (Standard of Living Index) is created using information on the type of household, amenities and ownership of goods.</p