title: Decision-making for delivery location and quality of care among slum-dwellers: a qualitative study in Uttar Pradesh, India.
abstract: In 2013, the Government of India launched the National Urban Health Mission (NUHM) in order to better address the health needs of urban populations, including the nearly 100 million living in slums. Maternal and neonatal health indicators remain poor in India. The objective of this study is to highlight the experiences of women, their husbands, and mothers-in-law related to maternal health services and delivery experiences.
  
  
  
  In total, we conducted 80 in-depth interviews, including 40 with recent mothers, 20 with their husbands, and 20 with their mothers-in-law. Purposeful sampling was conducted in order to obtain differences across delivery experiences (facility vs. home), followed by their family members.
  
  
  
  Major factors that influence decision-making about where to seek care included household dynamics and joint-decision-making with families, financial barriers, and perceived quality of care. Women perceived that private facilities were higher quality compared to public facilities, but also more expensive. Disrespectful care, bribes in the facility, and payment challenges were common in this population.
  
  
  
  A number of programmatic and policy recommendations are highlighted from this study. Future endeavors should include a greater focus on health education and public programs, including educating women on how to access programs, who is eligible, and how to obtain public funds. Families need to be educated on their rights and expectations in facilities. Future programs should consider the role of husbands and mothers-in-law in reproductive decision-making and support during deliveries. Triangulating information from multiple sources is important for future research efforts.
authors.affiliation: Department of Epidemiology and Biostatistics, UCSF, 550 16th Street, Box 1224, San Francisco, CA, 94158, USA. May.Sudhinaraset@ucsf.edu.|Global Health Sciences, UCSF, 550 16th Street, Box 1224, San Francisco, CA, 94158, USA. May.Sudhinaraset@ucsf.edu.
authors.forename: May
authors.initials: M
authors.lastname: Sudhinaraset
authors.affiliation: Global Health Sciences, UCSF, 550 16th Street, Box 1224, San Francisco, CA, 94158, USA.
authors.forename: Naomi
authors.initials: N
authors.lastname: Beyeler
authors.affiliation: Center for Operations Research and Training, 402, Woodland Apartment, Race Course Circle, Vadodara, 390 007, Gujarat, India.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Barge
authors.affiliation: Department of Epidemiology and Biostatistics, UCSF, 550 16th Street, Box 1224, San Francisco, CA, 94158, USA.|Global Health Sciences, UCSF, 550 16th Street, Box 1224, San Francisco, CA, 94158, USA.
authors.forename: Nadia
authors.initials: N
authors.lastname: Diamond-Smith
mesh_terms: D000328:Adult; D003657:Decision Making; D036861:Delivery, Obstetric / Q000523:psychology*; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000592:standards*; D011203:Poverty / Q000523:psychology*; D011204:Poverty Areas; D011247:Pregnancy; D036301:Qualitative Research; D011787:Quality of Health Care; D014505:Urban Population
keywords: Child health; Health providers; India; Maternal health; Quality of care; Social support; Urban health; Urbanization