Optimizing Maternal Healthcare Access: A Mixed Method Study on Dual Utilization of Public and Private Antenatal Care Services in Puducherry, India.

Abstract

Background: Access to antenatal care (ANC) services has improved. However, it is also noted that some antenatal women seek multiple healthcare services. Exploring this practice will identify gaps in service provision and pave the path toward improving the quality of services.

Objective: This study aimed to measure the concurrent use of public and private healthcare services for various components of ANC and understand the reasons for the dual utilization.

Methodology: This explanatory mixed-method study enrolled 177 mothers residing in Puducherry, who had given birth in the last three years. A pretested, semi-structured questionnaire was administered, and six key informant interviews were conducted. Integration was performed in the interpretation stage, and a joint display was used to depict the results. We adopted the Donabedian model during the analysis and organized the codes under these major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care.

Result: Most pregnant women (81.9%, 95% CI = 75.2%-86.8%) sought care from both public and private healthcare facilities, however, they preferred public facilities for delivery (74.6%, 95% CI = 67.6%-80.4%). The qualitative analysis revealed three major themes[1] Access;[2] Delivery of the Services;[3] and Quality of Care. Primary reasons for opting for private facilities included perceived superior ANC quality, organized care evident in scheduled appointments, reduced waiting time, frequent ultrasounds, personalized medication, and enhanced rapport with family. Women also believed that visits to government facilities are essential to avail the monetary benefits and have a seamless admission during delivery. They felt that government hospitals perform fewer cesarean sections.

Conclusion: Strengthening public-private partnerships could enhance antenatal care utilization, benefiting pregnant women and streamlining healthcare delivery.