women 's reproductive health is a major area of concern , especially in developing countries . maternal complications and poor perinatal outcome are highly associated with nonutilization of antenatal and delivery care services and poor socioeconomic conditions of the patient . more than half a million women die annually worldwide because of pregnancy - related complications . migration is the most observable and impressive fact in the growth of cities , and it is also considered as an essence of urbanization in the globe . in india , major cities have noticed an increase of around 75% population due to migration . migrants face numerous constraints , including lack of political representation ; inadequate housing and lack of formal residency rights ; low - paid , insecure , or hazardous work ; limited access to state - provided services such as health and education ; and discrimination based on ethnicity , religion , class , or gender . migrants face denial of basic entitlements including access to subsidized food , housing , drinking water , sanitation and public health facilities , and education and banking services and often work in poor conditions devoid of social security and legal protection . internal migrants in india constitute a large population : 307 million internal migrants or 30% of the population and by more recent estimates 326 million or 28.5% of the population . out of the total internal migrants , 70.7% are women . marriage is given as the prominent reason for female migration in both the rural and urban areas migration of women has been acknowledged as a demographic factor which affects the reproductive health of women . the migrant women , who move to the urban areas , face many challenges in relation to access to health care . a study showed that female migrants are vulnerable to environmental , social , and institutions forces that may affect their health - seeking behavior . women of socially disadvantaged groups , migrant , and/or from ethnic minority groups have been recognized to be less likely to receive early prenatal care and the necessary care during pregnancy , childbirth , and postnatal period . empirical evidence has pointed out that migrant groups face several barriers in accessing national maternal health services . maternity care is classed as essential care and so can not be refused due to inability to pay . there is no scope for special care for such vulnerable population in india , at present . women suffer more because though antenatal care ( anc ) services are available , they could not reach them . hence , assessment of present situation of migrant women with reference to anc services utilization and institutional deliveries becomes essential . thus , this study was conducted with following objectives among interstate female migrants . 
 to study socioeconomic and demographic profile of migrant womento estimate proportion of women utilizing full anc package and reasons for nonutilization of full anc servicesto estimate the proportion of institutional deliveries and reasons for home deliveries among the migrant women . 
  to study socioeconomic and demographic profile of migrant women to estimate proportion of women utilizing full anc package and reasons for nonutilization of full anc services to estimate the proportion of institutional deliveries and reasons for home deliveries among the migrant women . to study socioeconomic and demographic profile of migrant womento estimate proportion of women utilizing full anc package and reasons for nonutilization of full anc servicesto estimate the proportion of institutional deliveries and reasons for home deliveries among the migrant women . 
  to study socioeconomic and demographic profile of migrant women to estimate proportion of women utilizing full anc package and reasons for nonutilization of full anc services to estimate the proportion of institutional deliveries and reasons for home deliveries among the migrant women . a cross - sectional community - based survey was conducted among migrant women in reproductive age group in an urban slum of population ( 30,000 ) , which is the field practice area of a medical college . sample size was calculated using formula , where p is prevalence of the event , q is probability of nonoccurrence of event , and l is allowable error , the prevalence of anc services utilization according to the national family health survey-3 is 77% , and considering 10% allowable error , sample size comes approximately 120 . if there are no women fulfilling inclusion criteria in a randomly selected household , then next household was selected . if there is more than one woman in a household fulfilling inclusion criteria , then only one woman was selected by lottery method from that household . the national sample survey organization 2008 defined migrant as  a household member whose last usual place of residence ( upr ) any time in the past was different from the present place of enumeration was considered as a migrant member in a household .  in this survey , upr of a person was defined as a place ( village / town ) where the person had stayed continuously for a period of 6 months or more . full anc received by women : it is defined as having 3 components ( a ) at least 3 antenatal visits to health center , ( b ) at least 1 tetanus toxoid ( tt ) vaccine taken before delivery , and ( c ) consumption of 100 or more iron and folic acid ( ifa ) tablets . 
 migrants ( as per the above definition ) from outside maharashtra ( interstate migrants)married women in the age group of 1545 years who had delivered within last 2 yearsthose who consent was included in the study . migrants ( as per the above definition ) from outside maharashtra ( interstate migrants ) married women in the age group of 1545 years who had delivered within last 2 years those who consent was included in the study . interviews were conducted at the randomly selected households after getting informed written consent of participants . pretested semi - structured questionnaire for face - to - face interview was prepared . initial visits to the above - said areas were done to build rapport with the population as they are hesitant to get interviewed . their household was visited with the female social workers , and meetings conducted by social workers were attended . while interacting with the participants , one representative from the social workers was always present . data were coded , entered , and analyzed using open epi software ( open source epidemiologic statistics for public health)version 3.01 . chi - square test was used for evaluating association between anc utilization and categorical variables . the national sample survey organization 2008 defined migrant as  a household member whose last usual place of residence ( upr ) any time in the past was different from the present place of enumeration was considered as a migrant member in a household .  in this survey , upr of a person was defined as a place ( village / town ) where the person had stayed continuously for a period of 6 months or more . full anc received by women : it is defined as having 3 components ( a ) at least 3 antenatal visits to health center , ( b ) at least 1 tetanus toxoid ( tt ) vaccine taken before delivery , and ( c ) consumption of 100 or more iron and folic acid ( ifa ) tablets . migrants ( as per the above definition ) from outside maharashtra ( interstate migrants)married women in the age group of 1545 years who had delivered within last 2 yearsthose who consent was included in the study . 
  migrants ( as per the above definition ) from outside maharashtra ( interstate migrants ) married women in the age group of 1545 years who had delivered within last 2 years those who consent interviews were conducted at the randomly selected households after getting informed written consent of participants . pretested semi - structured questionnaire for face - to - face interview was prepared . initial visits to the above - said areas were done to build rapport with the population as they are hesitant to get interviewed . their household was visited with the female social workers , and meetings conducted by social workers were attended . while interacting with the participants , one representative from the social workers was always present . data were coded , entered , and analyzed using open epi software ( open source epidemiologic statistics for public health)version 3.01 . chi - square test was used for evaluating association between anc utilization and categorical variables . table 1 shows that 77% ( 93/120 ) of migrants were under the age of 29 years . sixty - two percent ( 74/120 ) of migrants were married before the age of 18 years though marriage before the age of 18 years is punishable by law . sixty - four percent ( 77/120 ) of migrants were belonged to lower socioeconomic class . sociodemographic profile of migrant women with their association with full antenatal care package utilization table 2 shows that almost three - fourth of migrants were hailing from uttar pradesh followed by bihar , i.e. 11.7% ( 14/120 ) . thirty - three percent ( 40/120 ) of migrants visited their native place at least once in 6 months . migration details of female migrants table 3 depicts that even after availability of reproductive and child health ( rch ) services in slum area , still 10% ( 12/120 ) of mothers did not register for anc services . registration percentage in the first trimester is less , i.e. , 21% ( 25/120 ) . these women could not be educated about various health topics such as nutrition , immunization , and family planning . nearly 63.4% ( 76/120 ) of mothers visited at least three times to health - care facility . thirty - seven percent ( 44/120 ) of mothers were not able to visit health - care facility at least three times . fourteen percent ( 17/120 ) of mothers did not consume a single tablet of ifa . ten percent ( 12/120 ) of mothers did not receive a single injection of tt . antenatal care services utilization by migrant women table 4 shows that 12% ( 15/120 ) of deliveries occurred in home . even after implementation of rch program with janani suraksha yojana which emphasizes on institutional delivery delivery practices of migrant women table 5 shows that most of the participants , i.e. , 30% ( 36/120 ) mentioned that too far location of government health facility was the most common reason for full nonutilization of anc services . they did not want to bear expenses toward traveling to health center , and visit to health center leads to loss of their daily wages . nearly 25.8% ( 31/120 ) migrant women did not think it is necessary to utilize full range of anc services . elder members in family did not allow 20.8% ( 25/120 ) anc mothers to go for regular anc visits as they did think it is necessary . they expect that their children should follow the same practice as they practiced at their time . poor quality service at health center 17.5% ( 21/120 ) was one of the important reasons mentioned by migrants . staff working at health center was not cooperative , spoke arrogantly , investigations and necessary medicines were not available are the reasons included in poor quality services . 15.8% of migrant women said they have not utilised anc services fully as they were not having any information ( lack of knowledge ) about this services . a study conducted in urban slums of delhi showed that majority of migrants were hindus ( 61% ) , aged 2429 years ( 44% ) , with a literacy rate of 38% . majority of migrants were muslims ( 73% ) , aged 1823 years ( 39% ) . twenty - seven percent were illiterates , and anc care utilization was significantly associated with religion and type of family . a cross - sectional study conducted in tribal blocks of maharashtra showed that anc registration in the first trimester is 63.8% , 82% received tt injections , 68.5% consumed ifa tablets , and 72% paid at least three visits to health centers . as compared to this study , in the present study , the percentage of anc registration in the first trimester is very low , i.e. , 21% . most of the anc migrants registered in the second trimester . almost 91% of migrant women received at least one tt injections . ifa tablets are consumed by all , but 100 tablets were consumed by only 28% of migrants . therefore , in the present study , ifa consumption and no of anc visits to health center are very less . these figures clearly point out toward the inadequate utilization of anc services by migrants women . a cross - sectional study was carried out among recently delivered women residing in tea gardens of darjeeling district of west bengal . it mentioned that the major barrier toward utilization of these services was ignorance followed by distance to the health - care center . according to the district level household and facility survey 2007/2008 , the percentage of institutional delivery and home delivery in urban area is 87.5% and 12.5% , respectively . delivery at home conducted by skilled health personnel was 2.8% . in the present study , a community - based cross - sectional study conducted in urban area in nainital district mentioned that high proportion of home deliveries even in urban area despite proximity to hospitals is a result of many factors including weak demand , minimal outreach services , weak community - provider linkages , and timings that often do not suit the daily - wage - earning urban poor . in the present study , out of 15 home deliveries , 11 deliveries reason mentioned was lack of transport facility to hospital . maternity care is an essential care which has to be made acceptable , accessible , and available at a cost affordable to women , but in case of migrant women , it is available but not acceptable and accessible due to above - mentioned reasons . the present study revealed low utilization of pregnancy - related health - care utilization among the study population . health - care workers and influential people from muslim community should be made aware and trained in explaining necessity of maternal and child health ( mch ) care . for this purpose , during health awareness session , elder members of the family specially mother - in - laws have to be involved on a priority basis and educated about importance of full anc care utilization and institutional delivery . if necessary , one - to - one counseling should be provided to convince them about correct practices . in the present study , the percentage of anc registration in the first trimester is very low , i.e. , 21% . moreover , migrant woman feels comfortable to conduct delivery by dai if she is available . it means that the message of  importance of institutional delivery  is not reached or convinced to beneficiaries . auxiliary nurse midwife , accredited social health activist , and anganwadi workers are not reached to them . then , it becomes necessary to train presently working and close to population dais also so that they will conduct deliveries following proper aseptic precautions , i.e. , to follow all 7 cs - clean hand , clean blade , clean cut , clean cord , clean tie , clean towel , and clean bed . poor quality service by health workers is one of the reasons for nonutilization of anc services . health - care workers should give sufficient time to counsel patients , or one counselor should be posted for a primary health center ( phc ) area ( six subcenters ) so that he / she should visit each subcenter under the phc area at least for a day in a week and educate groups or counsel patients on various health topics with proper feedback mechanism . frequency of outreach activities should also be increased for migrant women staying at a far distance from health center in slums which does not come under municipal corporation . this study can provide new insight for policy makers to devote resources for achieving the best possible quality of mch services .
introduction : migrant is a vulnerable population . they face several barriers in accessing health services . 
 the immigration status presents various challenges for maternity services utilization . 
 so this study was conducted ( 1 ) to estimate proportion of women utilizing full anc package and to find out reasons for its nonutilization ( 2 ) to estimate the proportion of institutional deliveries and reasons for home deliveries.methods:a cross - sectional community based study was conducted among migrant women in reproductive age group in an urban slum . 
 the sample size was 120 . 
 multistage simple random sampling was done.results:maximum numbers of migrants ( 71.7% ) were from uttar pradesh . 
 sixty two percent married before the age of 18 years . 
 full anc package was received by only 18% migrants . 
 proportion of home deliveries was 12% , and all were conducted by untrained dai . 
 lack of transport facility and availability of dai ( local birth attendant ) were the reasons mentioned for home delivery . 
 for nonutilization of full anc package , far location of health center ( 30% ) ; it is not necessary ( 25.8% ) ; and family did not allow them to visit health center ( 21.8% ) were the reasons mentioned . 
 religion and type of family were significantly associated with nonutilization of full anc package.conclusion:the present study revealed low utilization of anc services and high proportion of home deliveries among the migrant women even after availability of health facilities for providing anc care and to conduct deliveries in urban area .