title: Antenatal care service utilization in tribal and rural areas in a South Indian district: an evaluation through mixed methods approach.
abstract: BACKGROUND
  Maternal and child healthcare is one of the eight basic components of primary healthcare. Poor access and utilization of antenatal care (ANC) services continue to contribute to high maternal mortality and morbidity; and the services of primary healthcare are amenable for evaluation.
  
  
  OBJECTIVE
  To report the utilization of ANC services by women living in tribal and rural areas in the district of Visakhapatnam, Andhra Pradesh, India.
  
  
  METHODS
  Both qualitative and quantitative methods were used in the study. Quantitative data on ANC were collected from women having a child aged less than a year (n=380) through a structured interview schedule. The qualitative data were collected through indepth interviews with key informants in the villages (n=12).
  
  
  RESULTS
  The study reports higher utilization of ANC compared with the national average of India. A greater proportion of women living in tribal areas utilize the services from governmental sources (92%), whereas approximately 54% of the rural women seek services (paid services) from private practitioners. Health workers' visits match with the utilization of government health services.
  
  
  CONCLUSIONS
  The study showed relatively higher utilization of ANC services than the national average, but at the same time, child deliveries at home, which were mostly conducted by untrained elderly women, were also high. This gap is indicative of the target-oriented approach where quantity rather than the quality takes priority. In addition, the literacy levels of women, socioeconomic conditions and distance to the health facilities also played a role. To improve utilization and access, community health needs assessment has to be made, along with attempts to develop community participation.
authors.affiliation: aDepartment of Social Work, Andhra University, Visakhapatnam, Andhra Pradesh bCentre for Community Medicine, All India Institute of Medical Sciences cDivision of Health Systems Research, Indian Council of Medical Research, Ansari Nagar, New Delhi, India.
authors.forename: Godi Rajendra
authors.initials: GR
authors.lastname: Varma
authors.forename: Yadlapalli Sriparvathi
authors.initials: YS
authors.lastname: Kusuma
authors.forename: Bontha Veerraju
authors.initials: BV
authors.lastname: Babu
mesh_terms: D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008428:Maternal Mortality; D011295:Prenatal Care; D012424:Rural Population