title: A Survey of Obstetric Healthcare Utilization in the Rural Western Indian Himalayas.
abstract: Objectives To determine the socio-economic factors affecting access to antepartum, intrapartum, and postpartum healthcare in the rural Western Indian Himalayas over the past 20 years. Methods Face-to-face surveys were conducted with 197 women in Chamoli District, Uttarakhand from October 2011 to May 2012. Participants who gave birth within the past 20 years were included in the final analysis (n = 158). Stratified odds ratios and analysis of variance were calculated. Results Among women who delivered in the prior 7 years, there was a nine-fold increase (95 % CI 4-20.8) in institutionalized births compared to women who delivered 8-20 years before the study. Among women who delivered 7 years prior to the study, low income increased the risk of home delivery (OR 3.07, 95 % CI 1.15-8.54). Low caste (OR 2.79, 95 % CI 1.04-7.72) and low level of education (OR 3.93 95 % CI 1.41-11.81) decreased the use of antepartum medications (vitamins and vaccines). Remote location among all participants was a risk factor for not seeking care for obstetric morbidities (OR 0.44 95 % CI 0.2-0.95). Conclusions The incidence of institutionalized delivery has increased over the past decade in rural Uttarakhand. Income, caste, education, and remote location correlated with poor access to antepartum and intrapartum healthcare. These correlations have increased in statistical significance over the past 20 years, except for location. This indicates that the Western Himalayas face similar challenges to obstetric service utilization as the north Indian plains and that several of these inequalities in healthcare access have become more pronounced in recent years.
authors.affiliation: University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI, USA. prochase@med.umich.edu.
authors.forename: Erica C
authors.initials: EC
authors.lastname: Prochaska
authors.affiliation: Wildlife Institute of India, Chandrabani, Dehradun, Uttarakhand, India.
authors.forename: V P
authors.initials: VP
authors.lastname: Uniyal
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lanham
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.affiliation: Wildlife Institute of India, Chandrabani, Dehradun, Uttarakhand, India.
authors.forename: Shazia
authors.initials: S
authors.lastname: Quasin
authors.affiliation: Department of Botany, Jamia Hamdard University, New Delhi, India.
authors.forename: Monika
authors.initials: M
authors.lastname: Bisht
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011247:Pregnancy; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Antepartum health; Himalayas; India; Institutionalized delivery; Maternal health