BARRIERS TO ACCESS AND UTILIZATION OF MATERNAL AND CHILD HEALTHCARE SERVICES AMONG TRIBAL MOTHERS IN KANCHIPURAM-A MIXED-METHOD STUDY

Abstract

Background: Maternal and child health (MCH) is a key indicator of the effectiveness of a healthcare system. Tribal populations in India experience disproportionately poor maternal and neonatal outcomes, with higher perinatal risks and lower immunization coverage compared to the national average. Socio-cultural practices, poverty, geographic isolation, limited awareness, and systemic barriers significantly hinder access to essential maternal and child healthcare services. Objectives: To assess the maternal and child health profile of tribal mothers with under-five children in rural tribal areas of Kanchipuram district; to identify major barriers affecting access and utilization of maternal and newborn healthcare services; and to explore healthcare providers’ perceptions regarding challenges faced by tribal mothers. Methods: A community-based mixed-method study was conducted over three months (January 1–March 31, 2026) in Singadivakkam village, Kanchipuram. Seventy tribal mothers were selected using purposive sampling. Quantitative data were collected using a validated semi-structured questionnaire, while qualitative insights were obtained through one focus group discussion (n=7) and in-depth interviews with a Village Health Nurse and a Mid-Level Health Provider. Data were analyzed using descriptive statistics, chi-square test, independent t-test, and logistic regression. Thematic analysis, force field analysis, and trend analysis were performed for qualitative findings. Results: Most participants were aged 23–25 years (50%) and had education up to 8th standard (50%). Although 100% reported early initiation of breastfeeding and full immunization of children, 40% did not receive postnatal home visits, and 20% practiced pre-lacteal feeding. Monthly income showed a borderline significant association with health service utilization (χ²=7.82, p=0.05). Key barriers identified included financial constraints, transportation difficulties, early marriage, illiteracy, misconceptions regarding vaccination, and limited access to higher referral centers. Facilitators included community health worker support, financial incentives, free transport services, and regular health education sessions. Conclusion: Despite improvements in breastfeeding and immunization practices, tribal mothers continue to face socio economic and systemic barriers to optimal maternal healthcare utilization. Strengthening culturally sensitive health education, improving transportation and referral systems, and enhancing community-based outreach services are essential to ensure equitable maternal and child health outcomes among tribal populations.