Health outcomes depend on availability of and actual usage of formal institutional facilities. In this context, perhaps the most primary decision from a patient's point of view is to seek institutional care. The present study attempts to delineate main barriers of maternal health seeking behavior from select villages of Assam, an Indian state exhibiting highest MMR in spite of relative improvement in supply side scenario. Using multistage and snowball sample techniques, 169 interviewees are selected which include mothers who have children aged 0-24 months, subjects who are pregnant as well as members of families that have experience of maternal death. Data is analyzed with a Bayesian logistic regression model. Our analysis posits that non-availability of ambulance and female health providers; ignorance and hesitation; long queue at facilities, non-availability of supporting persons at home and heavy workload are main barriers to maternal health seeking behavior. Policy wise, the paper highlights the areas in which scarce public money should be spent.

This study examines socio-economic determinants associated with maternal mortality at disaggregated level in Assam, the state with highest maternal mortality ratio in India. An extensive door-to-door household survey was carried out during 2014-15 using multistage sampling to select villages in districts with high number of reported maternal deaths. The samples consist of currently pregnant women, mother with children 0-24 months and members of families who have experienced of maternal death. The study reveals that prevailing incidences of maternal mortality and maternal complications are the result of maternal anemia. Maternal complications are more likely to be associated with lower concentration of hemoglobin level, which is a proxy for maternal anemia. In addition, concentration of hemoglobin level is positively related to socioeconomic factors-literacy, land ownershipand habitat/occupation of the sample population. As a policy prescription, such findings should encourage the policymakers to identify context specific determinants of maternal anemia for appropriate interventions, instead of 'one-size-fits-all' type of approach.

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