Why women choose to give birth at home: a situational analysis from urban slums of Delhi.
OBJECTIVE
Increasing institutional births is an important strategy for attaining Millennium Development Goal -5. However, rapid growth of low income and migrant populations in urban settings in low-income and middle-income countries, including India, presents unique challenges for programmes to improve utilisation of institutional care. Better understanding of the factors influencing home or institutional birth among the urban poor is urgently needed to enhance programme impact. To measure the prevalence of home and institutional births in an urban slum population and identify factors influencing these events.


METHODS
Cross-sectional survey using quantitative and qualitative methods.


METHODS
Urban poor settlements in Delhi, India.


METHODS
A house-to-house survey was conducted of all households in three slum clusters in north-east Delhi (n=32 034 individuals). Data on birthing place and sociodemographic characteristics were collected using structured questionnaires (n=6092 households). Detailed information on pregnancy and postnatal care was obtained from women who gave birth in the past 3 months (n=160). Focus group discussions and in-depth interviews were conducted with stakeholders from the community and healthcare facilities.


RESULTS
Of the 824 women who gave birth in the previous year, 53% (95% CI 49.7 to 56.6) had given birth at home. In adjusted analyses, multiparity, low literacy and migrant status were independently predictive of home births. Fear of hospitals (36%), comfort of home (20.7%) and lack of social support for child care (12.2%) emerged as the primary reasons for home births.


CONCLUSIONS
Home births are frequent among the urban poor. This study highlights the urgent need for improvements in the quality and hospitality of client services and need for family support as the key modifiable factors affecting over two-thirds of this population. These findings should inform the design of strategies to promote institutional births.
Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India.
Niveditha
N
Devasenapathy
Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India.
Mathew Sunil
MS
George
Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India.
Suparna
S
Ghosh Jerath
Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
Archna
A
Singh
Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India.
Himanshu
H
Negandhi
Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India.
Gursimran
G
Alagh
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
Anuraj H
AH
Shankar
Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, Haryana, India.
Sanjay
S
Zodpey
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008875:Middle Aged; D057240:Patient Preference; D011204:Poverty Areas; D011247:Pregnancy; D014505:Urban Population; D055815:Young Adult
Public Health; Qualitative REsearch; Quality in health care