Women in Tamil Nadu prefer bigger hospitals, not PHCs, for delivery: Study

Chennai: Primary health centres – one of the first-line healthcare facilities in the state – can register pregnant women, offer vaccinations and medicines, and distribute maternity benefits. But deliveries must be held in bigger facilities such as medical collegfe hospitals or district headquarters hospitals, that have more medical facilities and experienced healthcare workers, a study by the directorate of public health concluded.

For the quantitative study, scientists interviewed women, who delivered in August 2022 in Tamil Nadu, using a semi-structured questionnaire. Of the 1,143 mothers approached for the study, 865 consented to participate in the study. Analysis showed 538 (62 per cent) women delivered at a public facility – this included 75 per cent of women in rural areas and 50 per cent in urban areas. “More than a quarter of women preferred medical college hospitals for deliveries,” said senior public health official Dr A Somasundaram, who is one of the authors of the study. The study was published in the state public health journal.

Public health facilities are sought after for registration and getting antenatal services as they are closer to home and not overcrowded. Even women who moved to private hospitals have taken antenatal services from the local PHCs. One in 10 deliveries happened in a PHC. Government records show deliveries in PHCs have come down from 28.3 per cent to around 10 per cent in a decade.

The place of delivery, however, is chosen predominantly based on distance, familiarity with the facility, and availability of skilled personnel and medicine, he said. In rural areas, health workers from primary health centres reach out to the mothers through field staff but in urban areas, the primary health infrastructure is not that strong. The role of field functionaries is limited to urban slums. Most women in cities access private facilities in the urban areas easily, the study found.

Tamil Nadu has the largest number of government medical college hospitals. Hence, medical college hospitals are more accessible for the patients to get delivered, avoiding anticipation of any further referral. “PHCs play a vital role in the preventive and primary healthcare needs of people. They do a variety of tests, offer medications, and counseling, and even remind patients to visit the doctor when visits are due. Women take vaccinations and bring their children for vaccinations to PHCs. When it comes to deliveries, different factors influence women,” said director of public health Dr T S Selvavinayagam. "The aim of this study is to ensure we make best use of the public health facilities," he said.