Healthcare expenditure, quality and accessibility as differentials in health-seeking behavior among women in rural India

Background: Healthcare-seeking behavior is affected by socio-economic, physical and cultural factors. Understanding these factors improves access to healthcare and focuses the development of health programs. Determinants that influence and differentiate healthcare-seeking behaviors for mothers compared to their child(ren) were studied. Methods: Cross-sectional health survey of women, 18-45 years, conducted by female interviewers in a hospital and sixteen surrounding villages in rural Gujarat, India. Respondents were asked the reason for postponing healthcare when they need it and those with a living child were asked the same regarding their child(ren). Results: Of 681 respondents, 493 reported having at least one living child. A majority of all respondents (57.4%) reported that they postpone healthcare. Mothers were less likely to postpone their child(ren)'s healthcare than their own (44.7% v. 60%). Of the mothers who postpone their own healthcare, 191 (64%) identified cost as the primary reason. In contrast, of those who postponed their child(ren)'s healthcare, only 72 (32.5%) did so because of cost (χ2,p<0.0001). Quality of care was more frequently the reason in postponing healthcare for children by mothers (25%) than for themselves (9.5%) (χ2,p<0.0001). Multivariate analysis indicates that impact of healthcare expenditure on family spending is the strongest predictor of healthcare-seeking behavior. Conclusions: Understanding the rationale and barriers for deferring healthcare is critical to improving access to care and reducing morbidity and mortality. Initiatives that address quality and perception of healthcare along with the burden of healthcare expenditure on family economics will be most effective and utilized by poor rural populations in India.