Tanveer Rehman1, Anish Keepanasseril2, Dilip Kumar Maurya2, Sitanshu Sekhar Kar3
1Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India
2Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
3Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Background: Availability of free/low-cost treatment in higher government facilities increases maternity self-referrals circumventing the referral system. We aimed to find the sociodemographic and health-care service delivery pattern among the pregnant women referred for institutional delivery in a tertiary care center in south India and assess factors associated with maternity self-referral from the perspective of pregnant women. Materials and Methods: We conducted a cross-sectional analytical study among pregnant women attending the antenatal clinic and admitted to the obstetric and postnatal wards during the 6-month study period. Interview was conducted using a face validated structured questionnaire. Statistical Analysis: Adjusted prevalence ratio (aPR) with 95% confidence interval (CI) was calculated to assess the independent effects of the sociodemographic and health-care delivery factors on maternity self-referral. Results: Mean age of 4191 pregnant women was 24 years (3.9). Forty-one percent (1732) of them had come without any referral, i.e., self-referred. Fifty-two percent (909) of these self-referred pregnant women were primigravida, 77% (1330) belonged to joint families and had nearest health facility within half hour distance from their own house. Nuclear family (aPR: 1.56 [95% CI: 1.45–1.68]), monthly family income >Rs. 3000 (aPR: 1.38 [95% CI: 1.28-1.49], and nearest health facility more than half-hour (aPR: 1.57 [95% CI: 1.45–1.69]) were factors significantly associated with self-referral. Conclusions: The study presents the alarming maternal referral system prevailing in nation as 41% (95% CI: 39.8%–42.8%) of maternal admissions in a tertiary care institute of South India were without any documented referrals.
Keywords: Cross-sectional, emergency obstetric care, maternal health services, referral and consultation.