Non-utilization of public health care facilities: examining the reasons through a national study of women in India.
BACKGROUND
This article examines women's opinions about their reasons for the non-utilization of appropriate public health care facilities, according to categories of their healthcare seeking in India.


METHODS
This cross-sectional article uses nationally representative samples from the Indian National Family Health Surveys NFHS-3 (2005-2006), which were generated from randomly selected households. Women of reproductive age (15-49 years) from the 29 states of India participated (n = 124 385 women). The respondents were asked why they did not utilize public health care facilities when members of their households were ill, identifying their reasons with a yes/no choice. The following five reasons were of primary interest: (1) 'there is no nearby facility'; (2) 'facility timing is not convenient'; (3) 'health personnel are often absent'; (4) 'waiting time is too long'; and (5) 'poor quality of care'.


RESULTS
Results from logistic regression analyses indicate that respondents' education, economic status and standard of living are significant predictors for non-utilization of public health care facilities. Women who sought the services of care delivery and health check-ups indicated that health personnel were absent. Service seekers for self and child's medical treatments indicated that there were no nearby health facilities, service times were inconvenient, there were long waiting times and poor quality health care.


CONCLUSIONS
This study concludes that improving public health care facilities with user-friendly opening times, the regular presence of staff, reduced waiting times and improved quality of care are necessary steps to reducing maternal mortality and poverty.
Dalal
Koustuv
K
Department of Public Health Sciences, Social Medicine, Karolinska Institutet, Stockholm, Sweden. koustuv.dalal@liu.se
Dawad
Suraya
S
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017150:Public Sector; D055815:Young Adult