Obstetric Care Seeking Process of Tribal Women in Karnataka, India Open Access

Abstract

Background: India has made significant improvements in reducing maternal mortality. However, these advancements are disproportionate across social groups, with rural tribal populations continually reporting the poorest maternal health indicators. Greater understanding of the obstetric care seeking processes of tribal populations is necessary for the national maternal health plans to be truly and equitably effective.

Goal: The goal of this study was to examine and compare the influential factors identified by Soliga tribal women along their pathway to obstetric care and the influential factors perceived by the maternal health workers that treat them to illuminate any disconnect.

Methods: In this qualitative study, in-depth interviews were conducted with 13 Soliga tribal women who had delivered a child in the past two years and 5 maternal health care workers. A case study on one of the women and an observation in an obstetric care facility were also conducted to add further context to the interview data. Thematic analysis was used to identify key themes across the data.

Results: Soliga women identified influential factors affecting four key stages of the obstetric care seeking process: deciding to seek obstetric care, choosing an obstetric care facility, reaching an appropriate obstetric care facility, and receiving adequate obstetric care. The women identified social support systems and situational knowledge as key facilitators in overcoming most access barriers except those related to patient-provider communication about referrals. Health workers' demonstrated varying levels of understanding of the tribal women's path to care but diverged in their perception of tribal knowledge, motivation, and negligence as barriers. Furthermore, health workers' perceptions of barriers differed based on their attitudes regarding the provision of care to tribal vs. non-tribal women, with the majority of divergent barriers being identified by health workers with accusatory attitudes.

Conclusion: The findings emphasize a need for maternal health programming that supports pre-existing social support systems, improves referral related communication, and trains health workers to deliver culturally sensitive obstetric care. Further research is required to investigate why the attitudes and levels of cultural sensitivity among health workers vary and what affect their attitudes have on the provision of care to tribal women.

Table of Contents

Abstract ...........................................................................iv

Acknowledgements ...........................................................vi

Table of Contents .............................................................vii

List of Tables and Figures ..................................................viii

Role in Thesis/Manuscript .................................................ix

List of Acronyms ...............................................................x

Literature Review ..............................................................1

Manuscript........................................................................14

Introduction .....................................................................15

Methods ...........................................................................18

Results .............................................................................25

Discussion ........................................................................40

Conclusion .......................................................................46

Public Health Implications .................................................47

References ........................................................................49

Annex 1: IDI for Soliga Women ...........................................53

Annex 2: IDI for Family Members of Soliga Case Study .......................55

Annex 3: IDI for Health Workers .......................................................56

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Asian Studies Women's Studies
Keyword	Health-Seeking Behavior Tribal Health Maternal Health India
Committee Chair / Thesis Advisor	Evans, Dabney, Emory University
Committee Members	Hennink, Monique, Emory University
Partnering Agencies	Community-based non-profit organization (e.g., AID Atlanta)

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