title: Preferences for infant delivery site among pregnant women and new mothers in Northern Karnataka, India.
abstract: BACKGROUND
  The National Rural Health Mission (NRHM) of India aims to increase the uptake of safe and institutional delivery among rural communities to improve maternal, neonatal and child health (MNCH) outcomes. Previous studies in India have found that while there have been increasing numbers of institutional deliveries there are still considerable barriers to utilization and quality of services, particularly in rural areas, that may mitigate improvements achieved by MNCH interventions. This paper aims to explore the factors influencing preference for home, public or private hospital delivery among rural pregnant and new mothers in three northern districts of Karnataka state, South India.
  
  
  METHODS
  In-depth qualitative interviews were conducted in 2010 among 110 pregnant women, new mothers (infants born within past 3 months), their husbands and mothers-in-law. Interviews were conducted in the local language (Kannada) and then translated to English for analysis. The interviews of pregnant women and new mothers were used for analysis to ultimately develop broader themes around definitions of quality care from the perspective of service users, and the influence this had on their delivery site preferences.
  
  
  RESULTS
  Geographical and financial access were important barriers to accessing institutional delivery services in all districts, and among those both above and below the poverty line. Access issues of greatest concern were high costs at private institutions, continuing fees at public hospitals and the inconsistent receipt of government incentives. However, views on quality of care that shaped delivery site preferences were deeply rooted in socio-cultural expectations for comfortable, respectful and safe care that must ultimately be addressed to change negative perceptions about institutional, and particularly public hospital, care at delivery.
  
  
  CONCLUSIONS
  In the literature, quality of care beyond access has largely been overlooked in favour of support for incentives on the demand side, and more trained doctors, facilities and equipment on the supply side. Taking a comprehensive approach to quality of care in line with cultural values and community needs is imperative for improving experiences, utilization, and ultimately maternal and neonatal health outcomes at the time of delivery.
authors.affiliation: University of Manitoba, Winnipeg, Canada. Sharon.Bruce@umanitoba.ca.
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Bruce
authors.affiliation: University of Manitoba, Winnipeg, Canada. blancha7@myumanitoba.ca.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Blanchard
authors.affiliation: Karnataka Heath Promotion Trust, Bangalore, India. kaveri.gurav1@gmail.com.
authors.forename: Kaveri
authors.initials: K
authors.lastname: Gurav
authors.affiliation: University of Manitoba, Winnipeg, Canada. aroy6520@googlemail.com.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Roy
authors.affiliation: University of Manitoba, Winnipeg, Canada. krishnamurthy@khpt.org.|Karnataka Heath Promotion Trust, Bangalore, India. krishnamurthy@khpt.org.
authors.forename: Krishnamurthy
authors.initials: K
authors.lastname: Jayanna
authors.affiliation: University of Manitoba, Winnipeg, Canada. mohan@khpt.org.|Karnataka Heath Promotion Trust, Bangalore, India. mohan@khpt.org.
authors.forename: Haranahalli L
authors.initials: HL
authors.lastname: Mohan
authors.affiliation: University of Manitoba, Winnipeg, Canada. bmramesh@khpt.org.|Karnataka Heath Promotion Trust, Bangalore, India. bmramesh@khpt.org.
authors.forename: Banadakoppa M
authors.initials: BM
authors.lastname: Ramesh
authors.affiliation: University of Manitoba, Winnipeg, Canada. james_blanchard@umanitoba.ca.
authors.forename: James F
authors.initials: JF
authors.lastname: Blanchard
authors.affiliation: University of Manitoba, Winnipeg, Canada. stephen.moses@umanitoba.ca.
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.affiliation: University of Manitoba, Winnipeg, Canada. Lisa.Avery@umanitoba.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Avery
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D016304:Hospitals, Private / Q000592:standards; D006779:Hospitals, Public / Q000592:standards; D006801:Humans; D007194:India; D007223:Infant; D009035:Mothers / Q000523:psychology*; D020380:Needs Assessment; D057240:Patient Preference; D018743:Perinatal Care / Q000379:methods / Q000458:organization & administration; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D058996:Quality Improvement; D012423:Rural Health; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors