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Table 8 A brief description of the framework used in qualitative data analysis understanding the maternal health care utilization of migrant women working in selected brick kilns in Faridabad, India

From: Maternal health care access among migrant women labourers in the selected brick kilns of district Faridabad, Haryana: mixed method study on equity and access

Thematic framework components and quotes Codes Summary Categories Subthemes Themes a
Reasons for migration to the place of work “NREGA payment is made after 2 ½ months...there is no timely payment of wages [at the place of origin]” “There is no work at my native place” Employment issues at the place of origin Failure of government to make timely NREGA payments along with lack of provision generating income compelled migrants to seek work elsewhere Difficulty in earning livelihood at the place of origin Delayed disbursement of NREGA 1
Labour intense work in brick kilns “We usually work from 4 in the morning till 7 in evening…once in a fortnight we get 2–3 days off” “Work here is strenuous” Working condition of migrant laborers working in brick kilns Many laborers including pregnant women worked for a long time in the brick kilns and also availed few number of leaves as obliged by their employer Difficult working conditions prevalent in the brick kilns Long working hours involving strenuous work. 2
Public health system at the place of work “Pregnant females are unaware about health matters” “People have told us that doctor comes here [brick kilns] to check pregnant females” Presence of public health facilities Due to faulty perceptions, lack of awareness migrant laborers rarely availed health services from the public health facilities Unawareness about local public health facilities Local public health system less utilized 3
Private health system at the place of work “We usually take medicines from one RMPa doctors who come in bicycle [to brick kiln]…and give their mobile numbers…when in need we will call them…for fever and cough we will have to spend ₹100 and for fluid infusion ₹1000..” Private health care easily available at the place of work Failure of public health system to identify and step up in providing health services, makes unqualified practitioners more appealing to the laborers, who usually provide substandard but costly health services. Private health care delivered at the place of work Substandard but costly health care availed from private providers Visiting brick kilns private providers induce migrants labourers to utilize private health service 4
Maternal health care availed by laborers “Sometimes we send pregnant women back home [place of origin] for delivery…in case of emergency we call our supervisor to take patient to government hospital” “We know of a RMP here and a hospital in Chhattisgarh. We have no information about ambulance.” Health care during pregnancy and child birth For child birth public health facility was preferred. However, many sent pregnant women to their place of origin for child birth resulting in discontinuation of health services. Lack of information about ambulance facilities at the place of work. Discontinuation in availing maternal health care Pregnant women working in brick kilns sent home for child birth 5
Perceived inability to avail maternal health care “There is no time left [to visit health facilities]” “We don’t know what kind of services are available here for pregnant women. Even if someone becomes ill we don’t know what to do” Barriers for universal health coverage Long working hours perceived to be barrier to visit nearby health facilities. Also, geographical location of brick kilns restricted laborers from visiting health centers after work hours. Poor utilization of health services Lack of time in brick kilns for visiting health facilities 6
Possible ways to deliver health care to migrant laborers in brick kilns “Doctors should visit bhatta [brick kiln] in evening” “It [visit to brick kilns by health providers] is good time in afternoon for health services” Concerted efforts required Need for health providers from the public health system for providing primary care in brick kilns was strongly desired. Migrant population need to be covered under public health system Need for providing primary health care in brick kilns Outreach services in brick kilns 7
  1. a Themes 1-Inability to earn livelihood at place of origin hence working in brick kilns was a feasible option; 2-Laborious work in brick kilns often involving pregnant women; 3-Gaps in knowledge regarding local health system; 4-Substandard informal health care delivered at brick kilns prevent migrants from accessing the basic public health services; 5-Misconceptions and mistrust about public health system influence maternal health care utilization; 6-Barriers to avail universal health coverage: location of brick kilns, time, apathy of public health system, partial health insurance cover;7-As part of universal health coverage concerted efforts by the public health system to address maternal health needs of migrant women
  2. NREGA National Rural Employment Guarantee Scheme; RMP Registered Medical Practitioner. However, in this context informal health provider without any government recognised medical degree