Women's Perceptions of Reproductive Healthcare in the Tribal Communities of Melghat, India

India will not meet UN MDGs 4 and 5 to reduce child and maternal mortality by 2015. Family planning (FP) and birth spacing (BS) are important for improved maternal and child health (MCH). Melghat is a remote tribal area in Maharashtra with high poverty and few health services. In 2012 Kasturba Health Society built a hospital in Melghat to provide prenatal care and safe births but utilization is low; 56% of births occur at home. The government funds community health workers (CHWs) who provide prenatal care and free contraception. CHWs are compensated for hospital deliveries and sterilization, but no incentive to teach about BS. The research aimed to understand women’s perspectives on family planning (FP) to inform community education about facility delivery. Structured interviews were conducted with 118 married women (age 18-45) from 19 villages to assess reproductive health histories, cultural beliefs, and FP. Mean respondent age=27 years, mean education=6 years. 94% knew at least one FP method (primarily sterilization 86%). For reversible methods 8% reported current use and 24% ever use. Reasons for stopping were plans to be sterilized, side effects, and inconvenience. CHW incentives for sterilization transcend education and socioeconomic status resulting in 52% being sterilized by age 22; 69% of women with 2+ children. Average BS was 19 months, with younger women knowing and desiring longer BS without means to do it. This research suggests the need for more comprehensive education regarding reversible methods and birth spacing to increase women’s choices and reduce maternal and child mortality.