Barriers in utilization and provisioning of obstetric care services (OCS) in India: a mixed-methods systematic review

Abstract

Background Despite the reduction in the maternal mortality ratio, barriers in obstetric care services (OCS) remain a significant risk factor for adverse maternal and perinatal outcomes in India. This review covers the ‘continuum of care’ (ANC, child delivery, and PNC services) and identifies multiple barriers in provisioning as well as utilization of OCS in India. We conducted a systematic review to understand the barriers using a mixed-methods approach. Methods PubMed, Scopus, Web of Science, Google Scholar, and Science Direct databases were searched from 1 January 2000 to 30 June 2022. The methodological quality of the included studies was assessed using appropriate tools. After a full-text review of 164 studies, total of 56 studies (33 quantitative, 18 qualitative, and 5 mixed-methods studies) were finally included in the review. All the barriers were classified into five major themes: (i) individual and interpersonal barriers, (ii) social and cultural barriers, (iii) structural barriers, (iv) logistical barriers, and (v) organizational barriers. A thematic synthesis approach was used to present the findings of the 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 often cited barriers to low institutional delivery and delayed ANC services. Long distances to health facilities and poor road conditions were the most frequently reported 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 This review identified several important barriers ranging from individual and cultural to structural, logistical, and organizational, which are prevalent in India. To mitigate the barriers, the governments need to develop strategies at the individual and organizational levels. Innovative interventions and program implementation at the community and village levels could also be contributory steps towards improving OCS utilization in India.

Maternal health service utilization in the Jimma Zone, Ethiopia: results from a baseline study for mobile phone messaging interventions

“…This finding aligns with earlier studies that have recognized economic hardships as a major obstacle in obtaining maternal healthcare in low- and middle-income nations [ 51 , 55 ], a study in Bangladesh, found that financial constraints significantly influenced the decision to seek maternal health services, with many women unable to afford the costs associated with healthcare visits, medications, and necessary tests [ 56 ], a study in India, found that financial limitations were a critical barrier to maternal health service utilization. Women from poorer households were less likely to access institutional deliveries and postnatal care due to the costs associated with these services [ 57 ], a study in Uganda highlighted that economic hardship was a major factor affecting maternal health service utilization [ 58 ], and research in Pakistan also demonstrated that financial barriers were a major obstacle to accessing maternal health services [ 59 ]. Improving access to maternal healthcare services requires addressing these barriers and empowering women through education and equitable healthcare access.…”