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Maternal health care utilisation in urban informal settlements: a grounded theory of manoeuvring

Alcock, Glyn; (2019) Maternal health care utilisation in urban informal settlements: a grounded theory of manoeuvring. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Despite substantial reductions, maternal and newborn mortality in India remain high. Access to maternity care is crucial, but research tends to emphasise uptake, overlooking patterns of utilisation. The urban scenario is complex: public and private health infrastructure is available but poorer groups face substantial inequalities in access. Understanding how families choose health providers and utilise services is essential to address inequalities and improve user experience. In this thesis, I examine the dynamics of maternity care-seeking in Mumbai’s informal settlements and develop a substantive grounded theory of health care utilisation. The study took place in informal communities in eastern Mumbai. Using mixed methods, I described patterns and determinants of maternity care, and used grounded theory to explain women’s choice of health care provider and utilisation of services. Uptake of institutional maternity care was high. Tertiary public hospitals were the commonest source of maternity care, but most women preferred the private sector because of superior quality and experiences. There were inequalities in uptake and utilisation across socio-economic groups. Motivated by an awareness of the potential risks of pregnancy and childbirth and a desire for positive health outcomes, families engaged in a process I called ‘manoeuvring’, a form of reflexive monitoring involving three interrelated stages: ‘exploring the options’, involving gathering information about health care options and providers, ‘purposive selection’, the identification of suitable providers, and ‘managing the health care encounter’, actions to move through the system, including negotiating with providers and reflecting on care-seeking experiences. In Mumbai’s informal settlements, institutional maternity care is the norm, although substantial inequalities exist. The process of choosing and utilising health care is complex. Manoeuvring explains how women living in challenging social and economic conditions choose and interact with health care services in a continuous process reflexive monitoring. Health managers must ensure quality services, a functioning regulatory mechanism, and monitoring of provider behaviour.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Maternal health care utilisation in urban informal settlements: a grounded theory of manoeuvring
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/ 4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10074542
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