Background: Despite focused national efforts to improve maternal health, utilisation of institutional childbirth services remains suboptimal among tribal communities in India. Challenging terrain, limited health-system infrastructure and entrenched socio-cultural norms contribute to reduced uptake in the tribal areas of Visakhapatnam district. Objectives: To identify the facilitators and barriers influencing utilisation of childbirth services among tribal women in Visakhapatnam by assessing infrastructure, access and stakeholder perceptions. Methods: A triangulated mixed-methods study was conducted from November 2018 to December 2020 in two tribal Primary Health Centres (PHCs)—one good performing (GP) and one very low performing (VLP). Quantitative data on childbirth indicators were extracted from the Health Management Information System and PHC records. Qualitative data were obtained through fifteen Focus Group Discussions with tribal women and eight Key Informant Interviews with health-care providers. Thematic analysis was undertaken. Results: In the GP PHC, skilled birth attendance increased from 94.6% to 97.7% between 2017 and 2020, and institutional deliveries rose from 72.1% to 82%. In contrast, the VLP PHC showed lower performance (skilled attendance: 68.4% to 75.1%; institutional deliveries: 69.3% to 68.1%). Caesarean section proportions were lower in GP (0.8–1.7%) than VLP (1.1–4.7%). Major barriers identified through FGDs included poor transport connectivity, fear of hospital procedures and household responsibilities. Facilitators included Accredited Social Health Activist support, incentive schemes and ambulance availability. Conclusion: Strengthening infrastructure, improving transport, enhancing community engagement and supporting frontline health workers are essential to improving institutional delivery uptake among tribal populations.
Burila et al. (Wed,) studied this question.