Nearly one in five mothers from Odisha’s Particularly Vulnerable Tribal Groups still gives birth at home, with poor transport and communication links preventing many women from reaching healthcare facilities in time, according to a new study published in Clinical Epidemiology and Global Health.
The study found that 77.9% of PVTG mothers delivered in institutions, well below Odisha’s overall institutional delivery rate of 93.1% and the national rate of 90.1%. Home deliveries accounted for 22% of births among PVTG mothers, compared with 7% across Odisha and 10% nationally.
Conducted across all 13 PVTG communities in eight districts, the research surveyed 1,186 mothers and examined childbirth care, the use of government services and out-of-pocket expenditure. Almost all institutional deliveries among the communities took place at government health facilities.
The findings show that a significant share of home births was not planned. About one-third of the home deliveries were unintended, meaning the mothers had intended to deliver in a hospital but could not reach a facility on time. Malkangiri recorded the highest share of such unintended home deliveries, according to the study, as cited by researcher Manas Ranjan Behera.
Poor communication and transport facilities were identified as the biggest reported reason for home births, accounting for nearly 30% of cases. Opposition from family or community members accounted for 23.1%, while the absence of female healthcare providers at facilities was cited in 16.2% of cases.
The study’s authors included researchers from the Indian Council of Medical Research, the Indian Institute of Public Health, Bhubaneswar, and KIIT. Lead author Jyoti Ghosal said the analysis found that access to antenatal care, mobile networks, all-weather roads and an Accredited Social Health Activist in the village significantly improved the likelihood of institutional delivery.
Villages with mobile connectivity were about 2.4 times more likely to record institutional births, while those with all-weather roads were 2.2 times more likely to do so, the research paper said. The findings indicate that maternal healthcare access in remote tribal areas depends not only on the availability of hospitals but also on the last-mile systems that connect villages to those facilities.
The research also highlighted the limited use of Odisha’s Maa Gruha maternity waiting homes. Only 13% of PVTG mothers surveyed had used the facilities. However, nearly 89% of women who stayed in a Maa Gruha eventually delivered at a healthcare institution.
The authors said that expanding awareness of the maternity waiting homes and improving access to them could help reduce home deliveries in remote areas. They also noted that free ambulance services and government assistance schemes had not eliminated transport difficulties, particularly where roads do not reach villages or become inaccessible during adverse weather.
Sanghamitra Pati, director of the ICMR-National Institute of Health Research in Bhubaneswar, was among the study authors who stressed the importance of improving road connectivity, mobile network coverage, transport planning and community awareness. These measures, the researchers said, will be critical to shifting the remaining home deliveries among Odisha’s PVTG communities towards safer institutional births.
