Determinants of place of delivery among women in indigenous communities of western India: A mixed-methods exploratory study

Background: Disparities in maternal and child health indicators in India's tribal regions are concerning, characterized by a high prevalence of home deliveries, which are linked to adverse obstetric outcomes, including maternal complications and mortality. Understanding the factors driving the choice of place of delivery is crucial for improving service uptake.Objectives: This study aims to identify the key enablers and determinants influencing the choice of place of delivery among indigenous mothers and to propose feasible solutions to enhance healthcare service utilization in this vulnerable population.Methods: A cross-sectional study employing a mixed-methods approach was conducted in a tribal district of Western India from July 2021 to March 2022. Quantitatively, we recruited an equal number of mothers (15 from each group) who delivered at home and in healthcare institutions using snowball sampling and random sampling techniques, respectively. The qualitative component included three Focus Group Discussions (FGDs) with mothers and seven In-Depth Interviews (IDIs) with primary healthcare providers to gain multi-stakeholder perspectives.Results: The study found that home deliveries were more prevalent among mothers engaged in seasonal migration for work, even during pregnancy (53.3% vs. 26.7% in the institutional delivery group). Among multigravida mothers in the home delivery group, 70% had delivered at home during their most recent pregnancy. A statistically significant association was observed between the current place of delivery and the last place of delivery (p = 0.024). Furthermore, 80% of infants born at home were delayed immunization as per age. Qualitative analysis identified key influencing factors, including seasonal migration, socio-cultural beliefs, geographical barriers, and teenage pregnancies.Conclusion: The choice of place of delivery in this tribal community is a complex outcome of past experiences, economic migration, and socio-cultural norms. To enhance healthcare service utilization, we recommend implementing a tracking system for migrating tribal women, providing culturally sensitive care, engaging local community influencers, and implementing targeted behavior change communication strategies.