Beyond the margins: antenatal health and healthcare behaviours among homeless women in Kolkata Municipal Corporation, India.

Despite high childbearing rates among homeless women in India, the antenatal health and healthcare behaviours among such population remain poorly understood. To address this research gap, a mixed-methods approach was employed in the present study, involving interviews with a sample of 400 women aged 15-49 years, utilising time and location sampling techniques. Additionally, a purposeful sample of 52 women from the same age group participated in in-depth interviews. The respondents exhibited rampant socio-economic backwardness, including chronic homelessness (36%), no formal education (54%), engagement in rag picking (31%), and low income levels. About 56% of the women reported poor self-rated health (SRH), notably higher among those aged 35 and above and those living alone (68%). Poor SRH was also prevalent among the ever married (61%), ragpickers (61%), beggars (62%), chronic homeless individuals (62%), tobacco (60%) and alcohol consumers (61%), and those with chronic diseases (61%). Common health issues included depression or anxiety (56%) and iron deficiency anaemia (35%). The level of unmet healthcare needs was 41%, with significant variation across diseases. Lack of reproductive health rights and awareness, socio-cultural beliefs, stigma, socio-economic poverty, poor quality of public healthcare services, irregularity in charity-run healthcare, and time constraints hindered antenatal care visits. The study underscores the urgent need for population-centric programmes and policies aimed at promoting reproductive health to achieve Sustainable Development Goal 3 of 'Good health and wellbeing' by 2030.