Reaching the hard-to-reach: Intranatal care utilization and out-of-pocket expenditure among the particularly vulnerable tribal groups of Odisha, India

Objectives This study examined intranatal care utilization (INC), out-of-pocket expenditure (OOPE) and related determinants among 13 particularly vulnerable tribal groups (PVTGs) in Odisha, India. Methods A total of 1186 PVTG mothers who had a recent live birth within the last 5 years, were interviewed using validated questionnaire. Utilization of INC service, Maa Gruha (maternity-waiting-homes), transportation services and related inflation-adjusted OOPE were estimated. Same rates were estimated for Odisha(n=7144) and India(n=176843) from National Family Health Survey-5. Survey-weighted multivariable logistic regression was performed to identify independently-associated factors. Results Institutional delivery among PVTG mothers (77.9%) were slightly lower than Odisha (93.1%) and national average (90.1%), although almost all delivered at public facilities. Government ambulances were used by 72.2%. Institutional delivery was positively associated with higher ANC utilization, all-weather roads, mobile network availability, and the presence of an ASHA in the village. Among home deliveries, 33.1% were unintended . About 57% of the PVTG mothers undergoing institutional delivery incurred median OOPE(INR 607) (Odisha-93%, INR 2851; India-77.5%, INR 2347). About 50% PVTG mothers delivering at home incurred OOPE(INR 358). Notably, only 13% mothers utilized Maa Gruha services, among them 10% incurred OOPE (INR 300). Conclusions PVTGs of Odisha reveals an appreciable institutional delivery rate and utilization of other public services, underscoring the reach and acceptability of state's public health system into the hard-to-reach communities. By addressing cultural, geographic, and infrastructural challenges through targeted interventions and multi-sectoral collaboration, further access to INC and subsequent improvements in maternal and child health are achievable.