India is a developing country that has pledged significant resources toward improving health care access for underprivileged citizens. Maternal well-being is a highlight of the government’s health care initiatives, especially in the state of Tamil Nadu where health care innovations and maternity assistance benefits for low-income women have become a model for the country. Despite improvement on key maternal health indicators over recent years, these health outcomes still lag behind those of more developed nations. In light of this maternal health outcome disparity, it is important to examine factors which may prevent low-income Indian women from accessing health care, as well as those factors which enable them to do so. Understanding such nuances in maternal health care access can impact the design of health system attributes and health initiatives which can better promote maternal well-being. This study draws from health care decision-making and health system frameworks as well as social relationship literature across disciplines to explore how low-income Indian women residing in Tamil Nadu understand and navigate their health care landscape. A convenience sample of 23 low-income women residing in Tamil Nadu, India were identified through snowball recruiting. Of these, 21 were mothers of young children or expecting mothers and two were key informants. Ages ranged from 20-35 years for current and expecting mothers. Study participants were interviewed using a semi-structured protocol. Data were analyzed using a Grounded Theory approach. Results show that these women encounter physical, financial, and informational constraints to health care decision-making and health care access. The study further finds that women utilize social relationships to assist in overcoming these constraints
