Understanding users' perspectives of barriers to maternal health care use in Maharashtra, India

This paper uses data collected using in-depth, semi-structured interviews t o examine utilization of maternal health care services among two rural and urban populations of Pune and Mumbai in Maharashtra. India. The study aims to identify key social, economic and cultural factors influencing women's d ecisions to use maternal health care and the places used for child delivery , whilst considering the accessibility of facilities available in the local area. Socioeconomic status was not found to be a barrier to service use wh en women perceived the benefits of the service to outweigh the cost, and wh en the service was within reasonable distance of the respondent's place of residence. A large number of women perceived private services to be superio r to those provided by the government, although cost often meant they were unable to use them. The provision of services did not ensure that women use d them; they had to first perceive them to be beneficial to their health an d that of their unborn child. Respondents identified the poor quality of se rvices offered at government institutions to be a motivating factor for del ivering at home. Thus further investigation is needed into the quality of s ervices provided by government facilities in the area. A number of responde nts who had received antenatal care went on to deliver in the home environm ent without a trained birth attendant. Further research is needed to establ ish the types of care provided during an antenatal consultation to establis h the feasibility of using these visits to encourage women, particularly th ose with high-risk pregnancies, to be linked to a trained attendant for del ivery.