Factors associated with utilization of antenatal care services among tribal women: A study of selected States

Abstract

Background & objectives:Despite various efforts by the Government of India, utilization of antenatal care (ANC) services continues to be low among women from rural areas particularly those belonging to the Scheduled Tribes. The present study was undertaken to examine the factors associated with the utilization of ANC services among women in four States including Rajasthan, Odisha, Chhattisgarh and Madhya Pradesh which constitute a good share of tribal population of the country.Methods:Data from third round of District Level Household and Facility Survey, 2007-08 (DLHS-3) have been used. Bivariate and multivariate analyses (logistic regression model) were used to study the association between the utilization of ANC services and the independent variables at individual, household and village levels along with the motivational factors (motivation by health workers and family members).Results:The utilization of ANC services among Scheduled Tribes women varied from about 4 per cent in Madhya Pradesh and Rajasthan to 10-14 per cent in Chhattisgarh and Odisha. Utilization was highest among those women with level of education 9th class and above (15-28%) and those women who visited health facility for pregnancy confirmation test (9-27%). Across the States, women who visited health facility for pregnancy testing (adjusted odds ratio, AOR = 1.5-2.5; P<0.001) except in Madhya Pradesh; registration of pregnancy (AOR = 2.1-4.5; P<0.01) and sought treatment of pregnancy related problems (AOR = 1.5-1.8; P<0.06) except in Rajasthan, were more likely to avail complete ANC services than their counterparts.Interpretation & conclusions:The utilization of antenatal care among Scheduled Tribe women across four States was very poor. The reasons behind non-utilisation include both socio-economic and health system factors. For improving ANC utilization among tribes, these factors need to be addressed with special emphasis on woman's educational attainment of high school and above. In addition, the study highlighted the need to create awareness among both pregnant tribal women as well as her family members on the importance of early ANC care.

Socio-demographic determinants of full antenatal care services utilization among pregnant women delivering at a tertiary care hospital in Haryana

“…So women with primary education were 94 percent less likely to receive adequate ANC than highly educated women. Adhikari et al (2016) [15] in their study also found that ANC utilization was highest among those women with level of education 9 th class and above (15-28%) which is also in concordance with the findings of present study. Majority (49.9%) of present study subjects had undergone 4-7ANC check-ups followed by 38.1% who had 1-3 ANC visits.…”

Refusal of antenatal care and the applicable conceptual models

“…ANC services are available in most settings and many women are aware of them. In low- and middle-income countries, the awareness is lacking in certain settings due to lack of female education [ 5 ], while the ready availability is compromised by misappropriation of limited resources.…”

Authors' Response

“…Critical reading of our article is appreciated. At a time when universal health care is being mentioned at the various national and international forum, our article depicts the poor state of ANC utilization among the tribal women in India 1 . There are other studies also echoing the same message 2 3 .…”

“…In our study, ANC registration and pregnancy testing were identified as the key determinants for complete ANC among the tribal women. Additionally, the role of family members in motivating women to attend the ANC clinic was emphasised in the States of Rajasthan and Odisha (Table 2A) 1 . Accessibility, however, in our analysis did not emerge as a determinant of ANC utilization.…”

“…Diversity of the nation in the ANC utilization was evident from the proportion of complete ANC in the four selected States and factors associated with it (Table I) 1 . This points towards the need to have State and district specific programmes for the improvement in ANC services utilization and maternal health.…”