# Insights into Public-Private Sector Variations in Maternal Health Care Utilization in an Urban Slum in Mumbai

## TL;DR

This study compares maternal health care use in public and private sectors in Mumbai's urban slums, finding differences in service quality, costs, and outcomes.

## Contribution

The study provides empirical insights into sectoral differences in maternal health care utilization and factors influencing sector switching in an urban slum setting.

## Key findings

- Private-sector registration was associated with higher maternal education, prior cesarean section, and pre-existing medical disorders.
- Private-sector deliveries had higher cesarean section rates and out-of-pocket expenditure compared to public-sector deliveries.
- Public-sector facilities performed better in newborn immunization and exclusive breastfeeding practices.

## Abstract

Introduction

Understanding variations in maternal health across public and private sectors is essential for improving service delivery. This study aimed to (i) compare maternal health service utilization across public and private facilities in an urban slum of Mumbai, and (ii) assess switching between sectors during childbirth and factors influencing it.

Methods

An analytical cross-sectional study was conducted from March 2023 to February 2024 among recently delivered women, selected through bi-monthly simple random sampling from health post and community health worker delivery records. Data were collected through household surveys and verification of health records. Variables included sociodemographic and obstetric profiles, core indicators of the antenatal care (ANC) process, delivery characteristics, and postnatal practices. Switching patterns between the registration sector and the place of delivery were assessed. Analysis included descriptive statistics, chi-square tests, and logistic regression.

Results

A total of 283 women were enrolled through systematic bi-monthly simple random sampling over the 12-month study period. Among them, 170 (60%) were registered in the public sector and 113 (40%) in the private sector. Higher maternal education (p<0.001), pre-existing medical disorders (p=0.004), and a previous cesarean section delivery (p=0.03) independently predicted private-sector registration. ANC utilization was high across both sectors, with no significant differences in core ANC components; however, Mother and Child Protection card coverage was higher in the public sector (p<0.001), while first-trimester ultrasonography was more frequent in the private sector (p=0.01). Sectoral switching between registration and delivery occurred in 31 women (11%), with no significant net shift (p=0.27). Cesarean section rates (p=0.01) and out-of-pocket expenditure (OOPE; p<0.001) were significantly higher in private facilities, whereas birth immunization (p=0.006) and exclusive breastfeeding at discharge (p<0.001) were better in public sector deliveries.

Conclusion

The study suggests that the public sector was the more frequent entry point for maternal care, while private-sector registration was associated with higher maternal education, prior cesarean section, and pre-existing medical disorders. The ANC quality was uniformly high across sectors and switching was low, driven by factors such as perceived quality of services and cost considerations among others. Private-sector deliveries had significantly higher cesarean rates and OOPE. Public facilities performed better in program linkage, newborn immunization, and exclusive breastfeeding practices. Strengthening coordination, standardizing obstetric practices, and reducing unnecessary interventions are essential to improve continuity, equity, and financial protection in urban maternal health care.