==== Front J Family Med Prim CareJ Family Med Prim CareJFMPCJournal of Family Medicine and Primary Care2249-48632278-7135Medknow Publications & Media Pvt Ltd India JFMPC-7-55710.4103/jfmpc.jfmpc_242_17Original ArticleFactors influencing utilization of reproductive health services among mothers in Meghalaya, India Nongdhar Jurysha 1Vyas Navya 1Rao P. Arathi 1Narayanan Prakash 1Pala Star 21 Department of Public Health, Manipal University, Manipal, Karnataka, India2 Department of Community Medicine, NEIGRIHMS, Shillong, Meghalaya, IndiaAddress for correspondence: Dr. Navya Vyas, Department of Public Health, Manipal University, Manipal, Karnataka, India. E-mail: navya.vyas@manipal.eduMay-Jun 2018 7 3 557 560 Copyright: © 2018 Journal of Family Medicine and Primary Care2018This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.Background: Antenatal care (ANC) is one of the basic components where it can provide pregnant women with an expansive scope of well-being, health promotion, and preventive health services. However, still 830 women die every day from preventable pregnancy-related causes, and 99% of these deaths occur in developing countries, out of which 20% of these deaths were from India. Objectives: The objective of this study is to explore the factors influencing the utilization of reproductive health services among mothers and to find the association between various factors and utilization of reproductive health services. Methods: A community-based cross-sectional study was conducted during January–June 2017 among 160 mothers who had an infant aged <6 months in Mawkyrwat Block, South West Khasi Hills District in Meghalaya. Respondents were selected through simple random sampling, and semi-structured questionnaire was used for data collection. Data were analyzed using SPSS 16. Results: Mothers attending four or more antenatal checkups were 10.6%, where 53.5% of the mothers registered their first ANC checkups only by the second trimester and 57.5% preferred home delivery. Nearly 52.9% of the mothers were staying more than 5 km away from the health-care facilities. The usage of family planning methods was very low, i. e., 96.9% of the mothers are not using any of the family planning methods. Conclusion: Study finding reveals that the utilization of health-care services was low. Area-specific approaches such as health camps and mobile clinics might result in improved utilization of reproductive health services. Antenatal care servicesantenatal careintranatal carereproductive healthutilization ==== Body Introduction In India, maternal and child health has remained an integral part of the Family Welfare Programme of India since the time of the First and Second 5-Year Plans (1951–1956 and 1956–1961) when the Government of India took steps to strengthen maternal and child health services. To improve the services, especially for people residing in rural and urban areas, the government has launched the National Health Mission (NHM) in 2005, i.e. to provide access to improved health care at the household level through Accredited Social Health Activist (ASHA) which acts as an interface between the community and the public health system. In some of the areas with limited resources, trained birth attendants (TBAs) help a women to delivered their babies at home.[1] The NHM envisages achievement of universal access to equitable, affordable, and quality health-care services that are accountable and responsive to people needs.[2] Under the NHM, a wide range of interventions have been ensured for effective health care, in spite of the availability of intervention reductions in maternal mortality and morbidity still remains a challenge. Under the NHM, they have come up with Meghalaya Maternity Benefit Scheme where incentives will be given to the mother with the aim to promote institutional delivery and to bring down maternal mortality.[3] Preventing death of the mothers during pregnancy and after the childbirth is one of the key interventions to bring down the maternal mortality.[4] In India, maternal mortality ratio (MMR) has declined from 178 deaths/100,000 live births in 2010–2012 to 167 deaths/100,000 live births in 2011–2013 and infant mortality rate of 40 deaths/1000 births in 2013.[4] These indicators will be the backbone of monitoring the progress toward the Sustainable Development Goals 2030 (SDGs), where SDGs target to reduce the global MMR to <70/100,000 live births.[5] The World Health Organization recommends a minimum of four antenatal care (ANC) visits, comprising interventions such as tetanus toxoid (TT) vaccination, iron-folic acid tablets, screening and treatment for infections, and identification of warning signs during pregnancy.[6] The health of mothers and the baby depends on an operational continuum of care with accessible, high-quality care before and during pregnancy, childbirth, and postnatal period.[7] According to the National Family Health Survey-4 (NFHS-4), in Meghalaya, mothers who had antenatal checkups in the first trimester were 53.3% and mothers who had at least four antenatal checkups were 50%. Mothers who had mother and child protection cards were 93.6%. In national surveys, it has been shown that mothers in West Khasi Hills District who had antenatal checkup in the first trimester were 36.3%, mothers who had at least four antenatal checkups were 40.4%, and mothers who had mother and child protection card were 94%. Mothers accessing modern methods of family planning services were 19.1%, intrauterine device was 2.4%, pills were 10.3%, condoms were 0.9%, and mothers who underwent female sterilization were 5.6%.[8] These data are indicative of the improper utilization of health services in the state. This study had been designed to understand the factors influencing the utilization of health services in the state. Methods A community-based cross-sectional study was conducted in Mawkyrwat Block, South West Khasi Hills District, Meghalaya. Mawkyrwat Block has 140 villages, 1 community health center, 2 primary health centers, and 13 subcenters. The sample size for the study was calculated as 158, based on the NFHS-4 result that 40.4% of the mothers had at least four ANC visits and a nonresponse rate of 10%. Data were collected during January–March 2017. A two-stage random sampling procedure was adopted for the study. At the first stage, 16 villages in Mawkyrwat Block were selected using simple random sampling technique. A list of all eligible mothers (who were having <6-month-old baby at the time of data collection) was prepared from the birth records maintained by ASHA for the selected villages. In the second stage, 160 eligible mothers were selected randomly from the list. Using a semi-structured questionnaire, face-to-face interviews were conducted among the selected mothers after obtaining the written consent. Kasturba Medical College and Kasturba Hospital Ethics Committee approved the study protocol, and permission was taken from the District Medical and Health Officer to conduct the study at Mawkyrwat Block. Data were entered and analyzed using Statistical Package for the Social Sciences version 16.0. The categorical variables were expressed in frequency and percentage and the continuous variable in mean and standard deviation. Chi-square test was performed to measure the association between independent variables and utilization of services. P < 0.05 was considered to be statistically significant. Results A total of 160 mothers having babies <6 months were interviewed. The mean age of the respondents was 27.8 years, and 45.6% were working as clerks, shop owners, or farmers. About 57.5% of the respondents belong to nuclear family. Almost 65% of the respondents had a family income of