Abstract
BackgroundWhile India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations.MethodsA population-based survey was carried out among 16 randomly selected rural villages in rural Mysore District in Karnataka, India between August and September 2008. All households in selected villages were enumerated and women with children 6 years of age or younger underwent an interviewer-administered questionnaire on antenatal care and institutional delivery.ResultsInstitutional deliveries in rural areas of Mysore District increased from 51% to 70% between 2002 and 2008. While increasing numbers of women were accessing antenatal care and delivering in hospitals, large disparities were found in uptake of these services among different castes. Mothers belonging to general castes were almost twice as likely to have an institutional birth as compared to scheduled castes and tribes. Mothers belonging to other backward caste or general castes had 1.8 times higher odds (95% CI: 1.21, 2.89) of having an institutional delivery as compared to scheduled castes and tribes. In multivariable analysis, which adjusted for inter- and intra-village variance, Below Poverty Line status, caste, and receiving antenatal care were all associated with institutional delivery.ConclusionThe results of the study suggest that while the Indian Government has made significant progress in increasing antenatal care and institutional deliveries among rural populations, further success in lowering maternal mortality will likely hinge on the success of NRHM programs focused on serving marginalized groups. Health interventions which target SC/ST may also have to address both perceived and actual stigma and discrimination, in addition to providing needed services. Strategies for overcoming these barriers may include sensitization of healthcare workers, targeted health education and outreach, and culturally appropriate community-level interventions. Addressing the needs of these communities will be critical to achieving Millennium Development Goal Five by 2015.
Highlights
While India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations
There were a total of 3,830 households in the 16 randomly selected villages enumerated during the period of the study
Demographics Only one in four mothers identified themselves as being part of a general caste which is not designated as deprived (22%; 303/1342), 15.9% (213/1342) reported being part of a Scheduled Tribe (ST), 27.8% (373/1342) Scheduled Caste (SC), and 33.3% (447/1342) reported belonging to ‘Other Backwards Castes’ (OBC), another poverty category that is low-income but generally less impoverished than Scheduled Castes and Tribes
Summary
While India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations. It has been more than a decade since the Millennium Development Goals (MDG) were adopted by the United Nations. Estimates from the Government of India National Family Health Survey (NFHS II, 1998-1999) suggest for instance, that maternal mortality could be as much as 132% higher outside of cities [6] In spite of these disparities most areas of India have still seen steady if not spectacular progress in reducing maternal deaths [7]
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