Publication:

Financial burden of intranatal care services: a study in Hassan district, Karnataka

Background In India, the financial burden of institutional delivery remains a major barrier to equitable maternal healthcare access. Significant cost disparities between public and private healthcare centres create substantial barriers, particularly for economically vulnerable households. Out-of-pocket expenditure on delivery care is a key driver of catastrophic health expenditure (CHE) among Indian households.

Methods A cross-sectional study was conducted including 415 mother who experienced institutional delivery. Cost data were classified into total direct and total indirect delivery costs. Statistical analysis used Welch’s t-test for comparing group means and Cohen’s d for effect size assessment. CHE was defined as total delivery cost exceeding 10% of household’s annual income.

Results The average direct cost of normal deliveries in private healthcare centres (₹34,270) was 48.5-fold higher compared to public healthcare centres (₹706). For caesarean deliveries, the average direct expense in private healthcare centres (₹69,981) was around 42 times greater than in public healthcare centres (₹1,647). However, total indirect expenses showed no statistically significant variation across centres and delivery types (normal delivery, p=0.189; caesarean delivery, p=0.081). CHE occurred in 56% of private healthcare centres users compared to 8% of public healthcare centres users. For cesarean deliveries, CHE occurred in 64.4% of private healthcare centres cases versus 11.8% in public healthcare centres.

Conclusions This study identified higher CHE in private healthcare centres; therefore, the government should regulate delivery costs in private healthcare centres and enhance quality facilities in public healthcare centres, and creating public awareness to promote their utilization.