Authors: Meerambika Mahapatro
Equity in health interventions has been emphasised and several national campaigns to improve maternal health and child survival have been launched through NRHM. In southern Orissa, India, the health indicators are remaining below compared to state & national average. We studied the influences that make pregnant women heed or reject referral advice. Both quantitative and qualitative data was collected using questionnaire interview with women having children below 1 yr old and 5 years old, married men and the key influencer and health professionals. 360 women were interviewed, 4 FGD with women and 4 with men, 20 health personnel and 10 key influencer were also interviewed. Indepth interview was carried with 10 women to identify barriers to use of health care facility. Analysis depicts risk status was found to have little influence on a woman's decision to seek hospital care. Besides geographical and financial barriers, we found that pregnant women have different perceptions and interpretations of danger signs. Furthermore, rural women avoid the hospital because they fear that no body would hear her voice. Hospital services should be reorganized to address rural women's feelings of fear and insecurity of spending more money. We conclude that a more individualised antenatal consultation could be provided by taking into account women's perception of risk and their explanatory models.
Keywords: Child survival, India, maternal health, health worker, ethnic community