Factors influencing the place of delivery in rural Meghalaya, India: A qualitative study

BACKGROUND: In Meghalaya, only 51.4% expectant mothers go for any institutional delivery with a wide rural-urban gap causing morbidity and mortality in the mothers and the neonates. OBJECTIVES: The objective of this study is to find out the factors influencing the choice of the place of delivery in rural women. METHODOLOGY: The present qualitative cross-sectional study was conducted from October to December 2016 in Bhoirymbong community health center (CHC) and the area catered to by it. This CHC was selected by purposive sampling. Data collection methods included focused group discussions and in-depth interviews. The data were analyzed manually using thematic content analysis. RESULTS: Most of the women in the study area opted for home delivery by traditional birth attendants (TBAs), on whose skills the community had strong faith. Financial constraints, fear of out-of-pocket expenditure, ignorance of available schemes, unavailability of transport, bad roads, and distant hospitals were found to be important causes of this choice. Home delivery apparently offered the women privacy and the opportunity to attend to their household chores and older children. Illiteracy, increasing age, and parity were risk factors for home delivery. Perceived need for institutional delivery was low. Staff attitudes and unnecessary referrals had an impact on the choice of place of delivery. CONCLUSION: In the rural areas of this study, home deliveries are the preferred norm. The wide range of factors identified in this study for the preference of TBA and home deliveries could help policy makers and program implementers to adopt socially and culturally appropriate community-based interventions that can contribute to the reduction of maternal, fetal, and neonatal mortality and morbidity and increase service utilization.