Background
Methods
Study participants and procedures
Data analysis
Ethical approval
Results
Participant demographic characteristics
Women (N = 40) | Husbands (N = 20) | Mothers-in-law (N = 20) | |
---|---|---|---|
Age, mean (IQR) | 26 (23–29) | 30 (25 to 32) | 54 (45–61) |
Hindu (N (%)) | 37 (93 %) | 19 (95 %) | 18 (90 %) |
Caste | |||
Scheduled Caste | 20 (50 %) | 6 (30 %) | |
Scheduled Tribe | 0 | 0 | |
Other backwards | 8 (20 %) | 7 (35 %) | |
None | 12 (30 %) | 7 (35 %) | |
Education | |||
No education | 11 (28 %) | 2 (10 %) | 16 (80 %) |
Less than 8 years | 9 (23 %) | 9 (45 %) | 3 (15 %) |
8 to 11 years | 15 (38 %) | 9 (45 %) | 1 (5 %) |
12 or more years of education | 4 (10 %) | 0 | 0 |
Occupation | |||
Not working outside the home | 35 (88 %) | 1 (5 %) | n/a |
Unskilled/skilled | 2 (5 %) | 9 (45 %) | |
Services | 2 (5 %) | 5 (25 %) | |
Sales | 0 | 5 (25 %) | |
Professional, technical, or managerial | 1 (3 %) | ||
Migration Status | |||
Entire lives | 0 | 13 (65 %) | 3 (15 %) |
< 1 year | 3 (8 %) | 0 | 0 |
1 year | 8 (20 %) | 2 (10 %) | 0 |
2–5 years | 16 (40 %) | 0 | 1 (5 %) |
5 to 10 years | 7 (18 %) | 1 (5 %) | 2 (10 %) |
More than 10 years | 6 (15 %) | 4 (20 %) | 14 (70 %) |
Place of residence before migration | |||
City | 32 (80 %) | 7 (100 %) | 15 (88 %) |
Town | 2 (5 %) | 0 | 0 |
Countryside | 6 (15 %) | 0 | 2 (12 %) |
Number of living children, mean (range) | 1.9 (1–7) | n/a | n/a |
Place of most recent delivery, N (%) | n/a | n/a | |
Government Hospital | 19 (48 %) | ||
Private Hospital | 10 (25 %) | ||
Lower level Facility | 1 (2 %) | ||
Home | 10 (25 %) | ||
Mean cost spent on delivery | 7,721 (0–12500) | n/a | n/a |
Mean cost spent on transportation to delivery | 334 (0–200) | n/a | n/a |
Widowed (Mother-in-laws only) | n/a | n/a | 6 (30 %) |
Decision-making about delivery location
Household dynamics: joint decision-making common
My sister-in-law’s children were also born there. My daughter’s children as well as my elder sister-in-law’s children were also born at [that] Hospital. My eldest grandson was also born there. (Mother-in-law, age 46)
My sister also went there for her delivery. From her pregnancy to delivery, she went there for all types of treatment. So on her suggestion, I went there. (Woman, age 34, 1 child)
Home or facility delivery: complications, costs, and perceived quality
Yes, she [mother-in-law] had also said that it is better to be in hospital --what if you start feeling unwell suddenly, or something else, require some machine, something, then all these facilities are there, at home you wouldn’t find all this (Woman, age 27, 2 children).
If [delivery] is done somewhere else like hospital, it costs a lot of money. It can be done at home for less money. And it is not possible to give proper care at the hospital, which can be done at home… It was right to do it at home, because we do not have so much money to take her to the hospital. They require money everywhere. Who’s going to give? It costs over twenty thousand rupees, how can we do it, tell us? That is why we do it at home. If it costs twenty thousand, from where do we get that kind of money? (Mother-in-law, age 60)There was a rumor in the village that I might have to pay after delivery—they [facility] might charge something. I am not able to pay; we don’t have that much money. So, I didn’t go there ever again….I am afraid that’s why I didn’t visit hospital; it’s good to bear pain and expenses in home; at least I’ll be happy at home. (Woman, age 35, 5 children)
We are poor and I have small children. If I stayed at home I would be able to take care of children and other thing, but if I stayed at hospital, how would my mother-in-law manage all these things? (Woman, age 35, 5 children)
Someone in the neighborhood told her [my mother-in-law] that if we cry and howl too much in the hospitals, they start hitting us. She got scared that ‘if my daughter-in-law gets troubled and if it is painful she will cry, and at that time if any nurse hits her.’…So she said it will be good if I deliver at home. (Woman, age 27, 2 children)
Rich people always get preference over poor. Poor people always stand in line while rich people get the direct entry. Poor people always suffer. That’s why many poor people hesitate to go to a facility…(Woman, age 35, 5 children)
Public or private facility: perceived higher quality in private sector
Private is best....In government there are no services. We have to stand in the queue for two hours, then your turn comes.....they do a simple examination and then inform you to come again day after tomorrow…. If you go to private, only money will be spent. Facilities will be availed quickly. (Husband, age 28, 2 children)
When we went there [public hospital], they admitted my wife inside. We sat there for almost 2-3 hours, my wife was suffering…I said it is no point tell me a place where I can take her..no one paid any attention to us, then I picked up my wife and got her to [private hospital]..then at [private hospital]..the doctor said for operation. (Husband, age 23, 1 child)
Yes, they said “come on daughter let’s go there in government hospital, if we go to private, it will be more expensive.” And there was not much problem. If problem is there, then to save oneself a person can go to private. We go to private if there is any problem. (Woman, age 26, 2 children)
Experiences in facilities
Disrespectful care common
The person who does delivery was speaking very rudely…they asked us to “get out from here, why are you gathering here, move, get out.” We were not allowed to stand outside even. (Husband, age 40, 1 child)
Wherever it is, in government hospital, all government hospitals and nowadays in private hospitals also, they say bad words....Doctor, no its nurse, she says inappropriate words and bad words. (Woman, age 30, 3 children)
Only if you have resources, or influence in the government, only then will you be listened to [at the facility]. Wherever you go-- private or government hospital-- you will be asked who are you, what do you do. If you say you work as a laborer, then no one will give you any attention. (Husband, age 24, 1 child)
Their services were very good. I mean whether it was staff related, doctor related. From conversation to everything was very good. My experience was very good. (Woman, age 34, 1 child)
Financial barriers: bribes and tokens paid to facility staff
The nurses demanded money.... I had a baby girl and after the delivery they kept her on the scale and demanded Rs.300-400. If I will not pay money they will not return my baby to me. We are poor and how will we have this much money to give? (Woman, age 26, 3 children)The gate peon was asking for money, and when baby boy was born I was sitting outside the operation theater when I went to get him they were asking that we give money so we give Rs.600. We took the baby boy and went upstairs for cleaning. There, everyone was asking for money – nurse, maid, everyone. Then they shifted her to another room, there were two people on the same bed…they asked for money again to shift her to an empty bed, then again for taking her to the room. So we gave money at 6-7 places…everywhere they asked for money. (Mother-in-law, age 50)
Financial barriers: payment challenges and difficulties with JSY payment
How did we bear the expense? As my husband is the only earning member and there are 8 people dependent on him, so we had to sell some of our household goods. (Woman, age 35, 5 children)That arrangement- I had taken advance from my employer and also borrowed some money from my relatives…My people are really nice, my relatives, my boss, they did not show any reluctance to give the money..[they] gave money with ease. (Husband, age 23, 1 child)
We had to borrow money…We did not feel nice. We had thought that in government hospital everything is free, so we won’t have to pay anything. But they referred us to private hospital, so we had to borrow money, which made us sad. (Woman, age 23, 1 child)
I will be able get it [bank account] opened with one thousand rupees. And we will get Rs. 1000 Rupees. So what is the benefit of getting it opened? (Woman, age 20, 1 child)
The service that we got, the cheque, we gave it all away. Everyone was asking for money, the nurse or the helper, everyone was asking for money. We gave them more than what we got. (Woman, age 20, 1 child)
I received a check but it is still not cleared. For clearance they are asking for [identification card]. They had given 3 months time, but to date I have not received the pehchan card, and the check is still lying with me uncleared. (Woman, age 26, 3 children)We had to get this scheme but we did not have any proof. They said if you have any residence proof or ID proof or anything, we did not have anything so we would have got the facility if we would have tried we would have got the money but we did not avail it, so we would say it is our mistake that we did not go again and try to get that money…When my first child was born I was given a voucher. We have to take it to the bank, I went there twice, [my husband] went twice to the bank and we spent 250 – 300 rupees as well but we did not get the money. Now I still have the cheque with me. (Woman, age 22, 2 children)