Socio-demographic factors affecting the choice of place of childbirth among migrant and native women - A case control study from Chandigarh, India.

OBJECTIVE: India is one of the countries with high maternal mortality ratio. Home deliveries persist despite various initiatives, including cash incentives, to promote hospital birth. This study aims to compare the profile of women who deliver at home and those who deliver at institutions with a special focus on migration status.

METHODS: A list of all women who delivered between January to December 2012 was obtained from the antenatal register of a polyclinic in Chandigarh, India. An unmatched case control study design was used to compare the profile of women who delivered at home and women who delivered in an institution.

RESULTS: Of 219 women studied, 57 (26%) had delivered at home. Our study identified being a migrant, having lower family income, living in slums, illiteracy of mother, early age at marriage, higher parity and no previous childbirth in an institution as factors favoring home delivery. Ninety three percent of home deliveries were among women who had migrated into Chandigarh from other states. The significant association between migration status and home delivery (Odds ratio (OR) = 3.262, p = 0.026) ceased to exist after adjusting for education (OR = 1.699, p = 0.367) and income (OR = 2.277, p = 0.152).

CONCLUSION AND CLINICAL IMPLICATION: Most home deliveries had occurred among migrant women. Health-related choices of the migrants apparently reflect the influence of other social determinants of health like education and income. Mainstreaming of the health efforts addressing the complex web of social determinants intertwined with the process of migration is the need of the hour.