Use Pattern of Maternal Health Services and Determinants of Skilled Care During Delivery in Slums of Gujarat, India

Abstract

Almost two decades since the initiation of the Safe Motherhood Initiative, every third pregnant women are delivered without skilled care. This study aimed to assess use pattern of maternal health services and factors affecting skilled care during delivery in urban slums. Methods: We have selected 562 women who delivered in last two year preceding survey using two stage cluster sampling for this community based cross sectional study. Information was collected using a pre-tested, structured interview schedule. Univariate and multivariate analysis were performed using SPSS 15.0 version. Result: Majority (92%) of women received at least one ANC care during their pregnancy. However, almost every fifth women didn’t receive skilled care during their last delivery. After controlling for confounding factors, the variables established significant association with health facility preference were high SLI (OR=1.12(1.09-1.16)), OBC caste group (OR=0.46(0.23 - 0.94)), more than two kilometer distance of maternity health facility (OR=0.38(0.22-0.65)), in education just literate (OR=2.46(1.02-5.91)), secondary (OR=2.25(1.02-4.97)) and higher secondary and plus (OR=4.87(1.2 – 19.76)), number of ANC care received once (OR=4.4(1.33-14.56)), twice (OR=4.77(1.55-14.68)) thrice and more (OR=14.82(6.25-35.11)), and second pregnancies (OR=0.44(0.21-0.94)). Less felt need, cost, societal barriers and personal perceptions were the reasons for not seeking care, whereas poor provider‘s attitude, poor quality of services and long waiting time were the reasons for not utilizing public health facilities. Conclusion: Household level resources, societal factors, availability of health services and health related behavior determine the use of skilled care during delivery need to address. Government sectors were found to be generally underutilized.