BARRIERS AND FACILITATORS TO INSTITUTIONAL DELIVERY AMONG PREGNANT WOMEN IN TRIBAL COMMUNITIES: A QUALITATIVE EXPLORATION

Abstract

Background: Institutional delivery is a proven intervention for reducing maternal and neonatal morbidity and mortality. Despite national programs such as the Janani Suraksha Yojana, utilization among tribal women in India remains low due to socio-cultural and structural barriers. This study explored the perceptions, barriers, and facilitators related to institutional delivery among tribal women in Kancheepuram district, Tamil Nadu.

Methods: A qualitative exploratory study was conducted between March and April 2025 in selected tribal villages. Purposive sampling recruited 28 participants, including 18 pregnant women or recent mothers and 10 key informants (ASHAs, ANMs, community leaders, health officials). Data were collected through four Focus Group Discussions (FGDs) and ten In-Depth Interviews (IDIs) using semi-structured guides. Transcripts were translated into English and analyzed thematically.

Results: Most women were aware of the benefits of institutional delivery but faced multiple barriers. Individual-level challenges included fear of hospital procedures, previous negative experiences, and lack of awareness among first-time mothers. Cultural and societal influences, such as preference for home births, decisions by elders, and restrictive gender norms, further constrained access. Structural and health system obstacles included distance, poor transport, inadequate infrastructure, and hidden costs. Facilitators included family support, peer influence, government schemes (e.g., JSY, ambulance services), and active engagement by community health workers.

Conclusion: Barriers to institutional delivery among tribal women are multifaceted, spanning individual, socio-cultural, and health system domains. Strengthening culturally sensitive health education, improving infrastructure, ensuring affordable transportation, and leveraging family and community support can enhance institutional delivery rates. Tailored, context-specific interventions are essential to reduce maternal mortality and achieve Sustainable Development Goal 3.