Underutilization of antenatal services among tribal women

Sir,

The study by Adhikari et al1 depicts sorry state of antenatal care (ANC) utilization among the tribal women in India. At a time when universal health is being echoed through the transition from the Millennium Development Goals (MDG) to Sustainable Development Goals (SDG), their analysis exposed our patchy success in promoting maternal health. This study though identified poor utilization of ANC services among study population but left scope for many unanswered questions.

Certain factors such as antenatal registration and pregnancy testing came up from the study analysis as the determinants for complete ANC. However, what motivates the women for registration and pregnancy testing is not clear. As evident from the findings, even education could not play a significant role in Chhattisgarh, a tribal-dense State, in encouraging people to take up such services1. What is more prominent from this study is that none of the socio-demographic factors plays vital role in promoting full ANC coverage. Highest coverage was seen among the women educated beyond middle school but that, too, failed to push the coverage beyond 30 per cent. Obviously, it calls for in-depth analysis of the factors related to service delivery.

Therefore, the study opens avenues for further research to explore other determinants of health-seeking behaviours. For example, we may consider the geographic distribution of tribal population in different States. If they are confined to certain pockets, what is the status of health care delivery system prevailing there? One needs to analyze accessibility and cultural factors for reaching a comprehensive understanding. A study from Kerala found the lack of public transport as a vital factor perceived by tribal women for not accessing ANC2. Motivation by health workers is another recognized factor in deciding utilization of care. Most importantly, we need a State-wise comparison of the tribal women with other sections of the society to find out the determinants of poor utilization. The analysis of data from south India earlier concluded that socially backward groups were less likely to reap the benefits of maternal health care3. Unless we recognize the reasons that have kept them behind, we cannot plan for a holistic development of the country, and it would be difficult to convert SDG into a reality.