Table 5 Community and Structural Facilitators

Availability of Public Transport

“My husband lives in Udaipur, so I am here alone most of the time. I have supportive neighbors who care for my children when I need help, but I usually don’t have anyone to accompany me to the hospital. I have been told by the ANM sister to visit the hospital during my pregnancy. So far, I have gone 3 times. I usually take the bus that comes to a stop 5 min away from my house. I do not know much about my health, but when I went to the hospital, I was given a bottle (IV Iron Sucrose).”

A majority of the participants displayed a strong reliance and trust in privately operated bus or auto transport as a means to reach the referral facilities. Since a large number of participants lacked access to personal vehicles, the accessible public modes of transport were observed to be strong facilitators for completing referrals, medical emergencies as well as deliveries.

ANM/ASHA Support

“My ASHA always comes to my house to remind me about health camps. When I had to go to the hospital, she accompanied me because I did not have anyone at home to take me. We walked for one hour to reach the hospital where I was given a bottle (IV Iron Sucrose).”

The village ASHA’s notable responsibilities include visiting beneficiaries houses to deliver health awareness messages and health camp reminders, conduct home based neonatal care to identify infant danger signs, and accompany pregnant women to their referral care visits and deliveries at higher level health centers. The latter provisions have been established to support mothers in travel, health system navigation and emotional distress. Several participants with low awareness or a lack of social support appreciated how their village ASHA would visit their homes regularly and accompany them to the primary health center for their antenatal care referral visits or deliveries.