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Background: "Chiranjeevi Yojana (CY)", a state-led large-scale demand-side financing scheme (DSF) under public-private partnership to increase institutional delivery, has been implemented across Gujarat state, India since 2005. The scheme aims to provide free institutional childbirth services in accredited private health facilities to women from socially disadvantaged groups (eligible women). These services are paid for by the state to the private facility with the intention of service being free to the user. This community-based study estimates CY uptake among eligible women and explores factors associated with non-utilization of the CY program.Methods: This was a community-based cross sectional survey of eligible women who gave birth between January and July 2013 in 142 selected villages of three districts in Gujarat. A structured questionnaire was administered by trained research assistant to collect information on socio-demographic details, pregnancy details, details of childbirth and out-of-pocket (OOP) expenses incurred. A multivariable inferential analysis was done to explore the factors associated with non-utilization of the CY program.Results: Out of 2,143 eligible women, 559 (26 %) gave birth under the CY program. A further 436(20 %) delivered at free public facilities, 713(33 %) at private facilities (OOP payment) and 435(20 %) at home. Eligible women who belonged to either scheduled tribe or poor [aOR = 3.1, 95 % CI:2.4 - 3.8] or having no formal education [aOR = 1.6, 95 % CI:1.1, 2.2] and who delivered by C-section [aOR = 2.1,95 % CI: 1.2, 3.8] had higher odds of not utilizing CY program. Of births at CY accredited facilities (n = 924), non-utilization was 40 % (n = 365) mostly because of lack of required official documentation that proved eligibility (72 % of eligible non-users). Women who utilized the CY program overall paid more than women who delivered in the free public facilities.Conclusion: Uptake of the CY among eligible women was low after almost a decade of implementation. Community level awareness programs are needed to increase participation among eligible women. OOP expense was incurred among who utilized CY program; this may be a factor associated with non-utilization in next pregnancy which needs to be studied. There is also a need to ensure financial protection of women who have C-section. [ABSTRACT FROM AUTHOR]

Background: Accessibility to maternal health care services for women in marginalized urban slum areas poses a huge public health problem. Many women do not go for institutional deliveries in spite of physical accessibility. Home-based care by Traditional Birth Attendants (TBA) is detrimental. Inappropriate early infant feeding practices are not uncommon. This study aimed to determine the existing maternal health care practices in an urban slum and to identify barriers to utilization of health services by mothers in the year 2010. Methods: This Cross-Sectional study was conducted in an urban slum area of Salatwada, Vadodara in India. Mothers who had delivered babies in last one year were contacted for the participation in the study. A total of 127 mothers were interviewed at home. Maternal health care practices and reasons for utilizing or not utilizing health services were investigated during the interview. Data were tabulated and analyzed using SPSS version 11.0. Results: Analyses showed that 74.8% of mothers had received antenatal care. However, this did not translate into safe delivery practices as 57.5% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (50.7%) or related to financial problems (24.6%). A total of 76.7% of the deliveries were conducted in the squatting position and in 37% of the cases, the edge of a broken cup was used to cut the umbilical cord. Although breastfeeding was started, inappropriate early infant feeding practices were common. A few mothers had breastfeeding problems. Conclusion: Inadequate utilization of available services leads to hazardous maternal health care practices in urban slums. [ABSTRACT FROM AUTHOR]