Abstract / Summary
In Madhya Pradesh, India, the Department of Public Health and Medical Education has undertaken initiatives to promote institutional deliveries in aspirational districts through community engagement and the involvement of frontline health workers. However, in districts with scattered settlements, hilly terrain, and difficult-to-reach hamlets, geographic and infrastructural barriers continue to constrain maternal health outcomes. In the tribal district of Barwani, traditional beliefs and cultural preferences further reinforce the community’s reliance on home-based deliveries, which increase the risk of preventable maternal and neonatal complications and deaths. To address these intersectional inequities in rural India, the Antara Foundation, a public health nonprofit, piloted a community-led Home Delivery Prevention Model in Pati block of Barwani district. The model aimed to quantify and address barriers contributing to home deliveries through the active involvement of the local community. Institutional delivery was used as a proxy indicator for access to institutional maternal care. This paper documents the implementation of the model that ensures institutional deliveries among pregnant women in ‘hard-to-reach’ hamlets (faliya) and explores how locally driven, community-led approaches can promote equitable access to public healthcare in remote, indigenous settings. The model, designed in December 2023 with the help of community volunteers, was implemented from January to June 2024. A mixed-methods approach was used, with quantitative analysis of government data to identify pilot areas. Content analysis of the qualitative data, which was collected by the implementation team from pregnant women and their families through FGDs and interviews, informed the community action. A purposive sample of 127 pregnant women was selected across five sub-health centres (SHCs) with the highest number of home deliveries. Data collected was stored, handled and managed ethically throughout the pilot, guided by the Declaration of Helsinki 2024. The intervention demonstrated preliminary improvements in family and local community support, resulting in institutional delivery for 83% of pregnant women who gave birth during the study period. This pilot study provides evidence that community-led models, grounded in local participation and integration with public systems, can enhance the uptake of institutional care in regions with high geographic and social inequities. In Madhya Pradesh, India, the Department of Public Health and Medical Education has undertaken initiatives to promote institutional deliveries in aspirational districts through community engagement and the involvement of frontline health workers. Despite ongoing government efforts, scattered settlements in hilly terrain and difficult-to-reach hamlets in some districts significantly limit the maternal health outcomes in remote communities. Additionally, in the tribal district of Barwani, due to traditional beliefs and cultural differences, the community prefers that women deliver at home. To address this multi-layered presence of health inequity, the Antara Foundation, a non-profit organisation, piloted a community-led model in one of the district’s administrative blocks, Pati. The intervention quantified the spread of geographical and institutional inequity in the block and, through targeted intervention, identified measures to address them locally. The proxy for institutional care was institutional delivery of pregnant women in areas with the maximum share of home deliveries. The model, designed in December 2023 and implemented from January to June 2024, tracked 127 pregnant women. In the five SHCs with the highest and moderate home delivery caseloads, 98 women delivered during the study period, of whom 81 (83%) delivered in hospitals, following targeted support and follow-ups by empowered community volunteers, tribal field coordinators, and frontline workers. This pilot study provides evidence on how community-led models, grounded in local participation and system integration, can enhance institutional equity in regions with high geographical and social challenges.