Intrapartum care among the urban poor in India: analysis of temporal dynamics in decision-making

Aim- To understand and explain the temporal process and dynamics of decision-making on intrapartum care for first births among the urban poor in India.
Methods- The study uses a qualitative longitudinal research design. Two stages of semi-structured in-depth interviews were conducted in January-July 2012 with primiparous women, as well as their husbands, mothers-in-law and/or mothers (depending on the composition of their household around the time of the birth). The first interview was conducted in the third trimester of pregnancy and the second within the first 8 weeks postpartum. 16 households were sampled purposively from 12 slums in Indore, Madhya Pradesh. Data were coded and analysed thematically.
Results- Households identify and register at a facility as a priority, but leave financial and transport arrangements until the final stages. Where intentions for home delivery are influenced by strong norms and/or lack of experience with the health system in general, planning and preparation is limited. Intentions may change during pregnancy and outcomes do not always match intentions, regardless of preparedness, due to multiple influences at the individual, household and health system levels. There is a need to reconceptualise decision-making and birth preparedness as temporal processes with non-linear courses of action.