The study of healthcare facility utilization problems faced by pregnant women in urban north India

Introduction

Most of the developing countries found it hard to meet the goal of the Millennium Development Goal 5 (MDG5), which was an attempt to reduce the maternal mortality at a global level from a high-level Maternal Mortality Ratio to a low [1], most the deaths can be prevented if predicted on time [2]. More than 500,000 women every year die due to complications of pregnancy and labor and developing countries comprise a whopping 99% of these deaths, unfortunately [3]. Almost 50% of these deaths occur in Sub-Saharan Africa and around 35% in Southern Asia and as a result 85% in both regions [4]. The pitiable situation around those areas is very alarming concerning maternal deaths, and this phenomenon may be a big threat around the world over. In developing countries, although the rate of births attended by skilled birth attendants has been increasing from 1990 to 2007 being 53–61% unfortunately more than 50% of births in South Asian and Sub-Saharan African countries still not attendant by a skilled birth attendant which is a big drawback in achieving the Millennium Development Goals [5].

According to World Health Organization, 2010 report the teenager maternal deaths between ages 15 and 19 years girls toll more than 70,000 due to early pregnancy in their life which also leads to the worry that around 60% of infants are at the risk of death because of the age of the mother is below 18 as compared to the infant if the mother’s age is above 18 [6].

The maternal mortality ratio (MMR) in India is on the high side, counting 136,000 maternal deaths estimated [7]. The main causes of barriers to utilization of maternal healthcare services in India are the cost of services, availability of services, awareness of services & corruption in services [8]. MMR for India was 254 by Sample registration system (SRS) 2006 estimate and came down to 212 per 100,000 live births by SRS 2009 estimate. Going by this pace we would achieve the MMR of 167 by the year 2013 and of 100 by 2017, far from the National Rural Health Mission (NRHM) goal of 100 per 100,000 live births by 2012 or the Millennium Development Goal of 109 per 100,000 live births by 2015 [9]. Most maternal deaths are recognized due to complications during labor and due to a lack of prediction of the complications [10]. If regular antenatal checkups, proper diagnosis, and management of labor complications are done on time, most of the deaths can be prevented [11].

This study is an attempt to find out the barriers to the utilization of maternal healthcare services and their management in urban districts of North India. These issues can be sorted out by reducing corruption in services, availability of services, accessibility of services, reducing the cost of services, and freedom of deciding on the time.

Most of the deaths occur due to barriers, and most of the barriers are due to a lack of knowledge. Researchers have found many issues related to barriers to the utilization of healthcare services, but still, we feel that many issues need to be addressed with a lack of support from the government at many levels. This study is a good piece of art that can highlight such issues. Therefore, the present study aims to assess the barriers to health care facility utilization in urban north India.

Materials and methods

Results

The 300 women taken for the survey were from different backgrounds, religions, and educational standards ranging from the 5th standard to graduation. Questions were asked from every woman and a few of the men, and all were married. The following facts were the findings of the study.

Discussion

The present study has found a lot of barriers like corruption in services, the hegemony of husbands and others, unavailability of services, unawareness of services, cost of services, and inaccessibility of services should be removed from the system. First to reduce the corruption at different levels like nurses asking for a bribe or patients fear disrespectful behaviour due to non-payment of bribes the ministry of health should send their people to check the condition of the hospitals from time to time by surprise visits which will make fear in the entire system of the hospitals. Another thing which is found is that women are not mostly free to make the decisions about when to go for the visit to the hospital or other healthcare facility without the permission of the husband or their in-laws, to overcome this issue it is required that the Anganwadi or Auxiliary nurse midwife (ANM) workers provide basic knowledge to the families and community about the pregnancy-related treatments and the importance of antenatal care visits on time without any hesitation. The men also should be provided knowledge of the healthcare facility utilization on time by giving mock drills or seminars by their related PHCs. Certain standards of cleanness are made by the National Rural Health Mission (NRHM) at the healthcare facilities but due to the lack of cleaning staff it’s not up to the mark, so to overcome this issue more sweepers or cleaning staff should be appointed. The number of doctors or nurses is not as much as required that’s why people are unable to get the service on time, to overcome this issue the government should increase the number of seats in medical colleges so that the Indian healthcare industry particularly the government sector may get more specialist doctors. Till the numbers of specialized doctors and nurses are not matched, the Bachelor in Unani Medicine and Surgery (BUMS) also should be given more chances at the healthcare facilities as the government gave chances to Bachelor of Ayurveda, Medicine, and Surgery (BAMS). At most of the healthcare facilities, the doctors prescribe private treatment at their clinics and prescribe medicines and pathological treatment at private pharmacies and laboratories and prescribe tens of medicines which are not required to the patients, and it just makes commission for the doctors, to overcome this issue a team of consulting doctors should be sent on primary healthcare center (PHCs) time to check what kind of reports of the doctors and nurses are giving from the health facilities from their areas and if any corruption is found the Medical Council of India (MCI) should cancel the licenses of such doctors. It is also found that most people are not much aware of where to go for certain treatments or what are the policies of the health facility, to overcome this issue the government should appoint more patient care officers under the rural health clinic (RCH) program, who can help the pregnant mothers in the health facilities and tell them things they did not know while they are waiting for their term to come, also try to reduce the waiting time for the patients which will only happen if the hospital has more number of doctors and nurses. The roads in the district are not very good and if the ambulance does not reach on time the pregnant women need to travel by public transport to reach to the health facility which is very risky, to overcome this issue the ministry of health, the government of India should provide better service of the ambulance with low cost because the private ambulances charge too much which is out of reach of the patients most of the time. Millennium Development Goals (MDG) of the United Nation should be achieved to reduce the maternal mortality, which includes eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality and empowering women, reducing child mortality, improving maternal health, combating HIV/AIDS, malaria and other diseases, ensuring environmental sustainability and developing a global partnership for development [16].