Community-led solutions to promote safe institutional deliveries in scattered tribal settlements of Madhya Pradesh, India.

چکیده اصلی

BACKGROUND: In Madhya Pradesh, India, the Department of Public Health and Medical Education has undertaken initiatives to promote institutional deliveries in aspirational districts through community engagement and the involvement of frontline health workers. However, in districts with scattered settlements, hilly terrain, and difficult-to-reach hamlets, geographic and infrastructural barriers continue to constrain maternal health outcomes. In the tribal district of Barwani, traditional beliefs and cultural preferences further reinforce the community's reliance on home-based deliveries, which increase the risk of preventable maternal and neonatal complications and deaths. To address these intersectional inequities in rural India, the Antara Foundation, a public health nonprofit, piloted a community-led Home Delivery Prevention Model in Pati block of Barwani district. The model aimed to quantify and address barriers contributing to home deliveries through the active involvement of the local community. Institutional delivery was used as a proxy indicator for access to institutional maternal care. OBJECTIVE: This paper documents the implementation of the model that ensures institutional deliveries among pregnant women in 'hard-to-reach' hamlets (faliya) and explores how locally driven, community-led approaches can promote equitable access to public healthcare in remote, indigenous settings. METHODOLOGY: The model, designed in December 2023 with the help of community volunteers, was implemented from January to June 2024. A mixed-methods approach was used, with quantitative analysis of government data to identify pilot areas. Content analysis of the qualitative data, which was collected by the implementation team from pregnant women and their families through FGDs and interviews, informed the community action. A purposive sample of 127 pregnant women was selected across five sub-health centres (SHCs) with the highest number of home deliveries. Data collected was stored, handled and managed ethically throughout the pilot, guided by the Declaration of Helsinki 2024. RESULTS: The intervention demonstrated preliminary improvements in family and local community support, resulting in institutional delivery for 83% of pregnant women who gave birth during the study period. CONCLUSION: This pilot study provides evidence that community-led models, grounded in local participation and integration with public systems, can enhance the uptake of institutional care in regions with high geographic and social inequities.

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