Why Institutional Deliveries are Low in Balrampur District Uttar Pradesh: A Cross-Sectional Quantitative and Qualitative Exploration.

Background: The rate of institutional deliveries in India is 78.5%. Kerala and Tamil Nadu (99.8%) had the highest numbers of institutional deliveries in 2010-13, but still it is less than 60% in about 170 districts in the country. Balrampur (Uttar Pradesh) has recorded the least institutional deliveries in the country.

Objectives: To assess the factors associated with low utilization of healthcare institutions for delivery in rural Balrampur district, Uttar Pradesh.

Methods: A community-based cross-sectional survey was conducted among mothers between the ages of 15-49 who gave birth 12 months before the study in Balrampur district, Uttar Pradesh. Both qualitative and quantitative methods were used for the study. Multistage random sampling was used to select the participants for the quantitative study. Qualitative data collection was done using in-depth interview among 10 women.

Results: Mothers who were not desirous of having more children had a 2.7 times greater chance of delivering at home compared to mothers who were desirous of having more children (OR 2.705, CI 95% 1.189-6.155). Women who married before 18 years of age had a greater chance of home delivery than women who married later (OR 2.381, CI 95% 1.034-5.482). Respondents living far away from home (more than 30 min-1 h travel) were more likely to deliver at home compared to those living close by (OR 2.385, CI 95% 2.357-8.028). Women who were unaware of complications of pregnancy were more like to deliver at home compared to their counterparts who were well aware (OR 2.355, CI 95% 1.677-3.309). Qualitative data showed that cultural beliefs, financial problems, lack of decision making power by the pregnant women were significant determinants of non-utilization of institutional deliveries.

Conclusion: Despite the cash incentive program, strong cultural and social factors prevent women from accessing institutional deliveries in Balrampur district of UP.