Telemedicine as a “digital umbilical” for maternal and reproductive healthcare: a qualitative study from health and wellness centers in rural West Bengal, India

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BACKGROUND: Rural women in India continue to face major geographical, financial, and sociocultural barriers to get timely maternal and reproductive healthcare, despite recent investments in primary care infrastructure and digital health initiatives. The West Bengal state telemedicine program, where patients are delivered healthcare through Health and Wellness Centres (HWCs), offers a hybrid model that combines on-site Community Health Officers (CHOs) with remote physicians, but its functionality for reproductive health remains underexplored. METHODS: This descriptive qualitative study explored staff experiences of implementing and delivering a hybrid telemedicine model for maternal and reproductive healthcare at peripheral Health and Wellness Centers (HWCs) in two West Bengal districts selected for their differing health system capacities. In total, 23 in-depth interviews were conducted with CHOs, Medical Officers, IT staff, and program administrators involved in telemedicine systems at HWCs and linked facilities in the selected two districts (Nadia and Howrah). The collected interview data were analyzed using reflexive thematic and sentiment analysis. RESULTS: Participants described telemedicine as a bridge that connects rural women, especially older, low-income, and socially disadvantaged clients for getting specialist guidance while preserving free medications, reducing travel, and strengthening continuity of care for general and reproductive health needs. Across the reproductive continuum, teleconsultations supported safer family planning, triage and co‑management of high‑risk pregnancies, and follow‑up for minor post‑partum complications, anchored by CHOs' physical assessments. In the studied telemedicine system, recurrent barriers include doctor unavailability, pressure to meet daily case targets, incomplete clinical information, and weak digital infrastructure. These led to rushed consultations, generalized prescriptions, and limited suitability of telemedicine for emergencies or complex gynecological assessment. CONCLUSIONS: Hybrid telemedicine at HWCs can substantially narrow access gaps in maternal and reproductive healthcare in rural settings when CHOs are empowered as skilled on-site assessors and consistent remote clinical support is available. To realize its full potential, programs must rebalance quantity-driven targets with quality, invest in joint training for CHOs and physicians, and address persistent infrastructural bottlenecks so that telemedicine can function as a reliable screening and support system rather than a substitute for essential in‑person care.

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