Table 3 Qualitative data analysis from the rapid assessment at baseline

Perceived awareness and utilization of MCH services by women

a. From the discussions with women

Women appeared to have little information on newborn and child care practices, including breastfeeding, and newborn hygiene. Their utilization of antenatal services was perceived poor. Most of the women seemed to have been dependent on mothers-in-law for any health-related problem of their children.

We visit doctors only in case of acute illness and not routinely for an antenatal check-up during pregnancy.

We are poor and illiterate women who do not know about medical check-ups during pregnancy. I have not been told or asked by anyone to go to the doctor for a check-up. (Women during FGD)

There is an exploitation of poor people at the PHCs. The medicines prescribed need to be purchased from private medical stores. If there are good medicines at PHC, we will surely buy from there for our treatment. (Women during FGD)

My child suffered from pneumonia, and I took him to the government hospital, but there was no relief. Then, I took my child to a private hospital where my child fully recovered. (Women during FGD)

A few women seemed to know about family planning methods. However, the uptake of contraceptives was perceived poor because women were hesitant to talk about them, they appeared to have limited knowledge about them, a lot of misconceptions about their side effects prevail in the society, women seemed to lack negotiation skills, non-cooperating attitude of husbands, and unavailability of contraceptives at health facilities.

b. From the interviews with healthcare providers

Medical officers revealed that the institutional delivery rate has improved in their areas, which might be due to the launch of the maternity benefit scheme (Janani Suraksha Yojna; JSY). Community health workers informed that women preferred to deliver in a district-level hospital instead of a PHC because of a lack of adequate facilities and pediatricians for the care of the newborn in PHCs.

JSY has a big role in promoting institutional delivery at government service centers. (A medical officer during IDI)

Perceived support from family (husbands or mothers-in-law) for accessing MCH services

Women in some of the FGD reported a lack of support from husbands for institutional delivery or to work outside their homes.

Husbands denied permission for delivery at PHC and did not want money given under the JSY scheme. (Women during FGD; JSY is maternity benefit scheme)

Men in the community wanted delivery to happen at home. They went to doctors only if their wives developed some problems after delivery. (Women during FGD)

Our society is a male-dominated society. In some cases, it’s a male’s ego, which does not allow men to let their wives work outside their home and earn some money. (Women during FGD)

Perceived utilization of the MGNREGA scheme by women

A fewer number of women went to work under MGNREGA. Many women who started working under MGNREGA left it once they became pregnant. The MGNREGA staff mentioned that various services were provided to pregnant women at the worksites such as drinking water and medicines, a shed to feed their children. However, most of the women did not continue for a very long time.

Yes, the women may feel difficult to work at MGNREGA sites because of their pregnancy or because they had delivered a baby. Repeated childbirths deprive them of good health and stamina, and the mothers are not able to produce output at the work sites. (A MGNREGA staff)