Addressing barriers in utilization and provisioning of obstetric care services (OCS) in India: A mixed method systematic review

Abstract

Background: Despite the reduction in the maternal mortality ratio, Obstetric care service (OCS) barriers remain the significant risk factor for adverse maternal and perinatal outcomes in India. This review is relevant because it covers all three obstetric care components (ANC, child delivery, and PNC services) and identifies multiple barriers from provisioning to utilization of OCS in India. We conducted a systematic review to address the barriers in utilization and provisioning of OCS in India using a mixed-method review. Methods: PubMed, Scopus, Web of Science, Google scholar, and Science direct databases were searched from 1st January 2000 to 30th June 2022. The methodological quality of included studies was assessed using appropriate tools. We have included 56 studies (33 quantitative, 18 qualitative, and 5 mixed method studies) after 164 full texts review. All the barriers are classified into five major themes, i.e. (i) individual and interpersonal barriers, (ii) social and cultural barriers, (iii) structural barriers, (iv) logistical barriers, and (v) organization barriers. Thematic synthesis approach was used to present the findings from 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 reported barriers to low institutional delivery and delayed ANC services. Additionally, long distances to health facilities and poor road conditions were the most frequent 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: Governments should take necessary steps to tackle the mentioned barriers and encourage women to make their own health decisions. Keywords: Obstetric care service; Barriers; Maternal Health; Systematic Review; India