Healthcare behavior and expenditure in an urban slum in relation to birth experience and newborn care

J Trop Pediatr. 2012 Jun;58(3):214-9. doi: 10.1093/tropej/fmr073. Epub 2011 Sep 10.


Background: Newborn care practices and healthcare seeking are important determinants of neonatal morbidity and mortality in the resource-limited settings of the urban slums.

Objectives: To examine the current patterns of healthcare-seeking behavior and estimate out-of-pocket expenditure for delivery and common neonatal problems in the urban slums of Chandigarh.

Study design: Community-based cross-sectional survey.

Materials and methods: Structured questionnaire was used to collect data from the clusters selected by the World Health Organisation (WHO) Expanded Program for Immunization's cluster survey method.

Statistical analysis: Independent t-test, one-way ANOVA and Pearson's Chi-square tests were used to analyze the data. All tests were two-tailed and p < 0.05 was taken as significant.

Results: 31.7% of the mothers delivered at home with 4.18 ± 2.16 mean number of antenatal visits and 73.9% used prelacteals. Factors significantly predicting home deliveries were identified. About 44.7% of the neonates had problems after birth, with 40.3% requiring hospitalization. Choice of private healthcare providers governed the care seeking in the majority (61.4%). Out-of-pocket expenditure was significantly high for the private care providers in terms of the cost of delivery and the overall cost of neonatal illness though no gender-based differences were seen.

Conclusion: Private sector emerged as the major healthcare provider in the urban slums resulting in higher out-of-pocket expenditure. A comprehensive health strategy comprising of health education, improvement in antenatal practices, institutional deliveries, behavior change communication activities and quality perinatal care is required for these urban slums.

MeSH terms

  • Community-Based Participatory Research
  • Cross-Sectional Studies
  • Female
  • Health Behavior
  • Health Expenditures*
  • Humans
  • India
  • Infant, Newborn
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Perinatal Care / economics
  • Perinatal Care / methods*
  • Poverty Areas
  • Pregnancy
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Urban Population