The role of social support in the decision to migrate for childbirth: qualitative evidence from India

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Temporary Childbirth Migration (TCM) involves women returning to their natal homes during or after pregnancy, a common but understudied practice in India and South Asia. This study examines social support practices influencing TCM decisions among Indian women. Factors such as family support, especially from husband, in-laws and parents, play a crucial role in migration decisions during the perinatal period. Understanding these factors is essential for improving maternal and child health outcomes and for developing targeted policies and interventions. Cultural influences also contribute to TCM decisions, impacting the timing, duration, and motivations behind women's choices to migrate during or after delivery. Our study was conducted at the Vadu Health and Demographic Surveillance System (HDSS) in Western Maharashtra, India. We conducted 41 in-depth interviews with triads of women, their husbands, and mothers-in-law from Vadu HDSS, focusing on perceptions, timing, reasons, decision-making, and support related to Temporary Childbirth Migration (TCM). Participants varied in age, education, occupation, marriage type, migration type, delivery method, and included women who recently delivered or had infants up to two years old. The qualitative data were analyzed using both rapid analysis and traditional analysis using coded transcripts, incorporating both predefined and emergent codes to capture a wide range of participant characteristics and experiences. We later categorized our findings in Social support domains. Social support, including emotional, financial, instrumental, and informational, is a critical factor in TCM. Emotional support from mothers is highly valued, providing a stress-free environment. Financial support from husbands, in-laws, or parents influences the decision, with financial responsibilities sometimes dictating the choice of residence. Instrumental support, such as help with household chores, is essential, with varying levels of support at different locations. Informational support from experienced family members also guides expectant mothers. Healthcare access, household status, and the role of husbands further impact TCM decisions. Women prioritize proximity to medical facilities, comfort, and freedom in their natal homes. The inclusive decision-making process often involves women, in-laws, parents, and husbands. The study's findings highlight the complex interplay of social support, cultural norms, and practical considerations in TCM decisions, underscoring the need for more research to understand and support women's choices during the perinatal period. In conclusion, social support is a key driver of TCM and women's status in their households affects their support needs. Recognizing the importance of emotional, financial, informational, and instrumental support will help healthcare providers and policymakers to better assist expectant mothers, promoting positive maternal and child health outcomes.

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