Abstract
BackgroundIndia has focused on incentivizing institutional delivery and introducing the ASHA worker as a key strategy to improve maternal health outcomes. We examined the determinants of institutional delivery and the role of the ASHA worker in shaping choice regarding place of delivery.MethodsWe used data from the India Human Development Survey-II conducted in 2011–12, and extracted an analytic sample of women (N = 8711) who reported having at least one child since 2005. Logistic regression was used to examine influence of socio-demographic factors, frequency of antenatal care (ANC) contacts and exposure to ASHA worker on institutional delivery.ResultsAbout 15% of the respondents had eight or more ANC contacts. The odds of having an institutional delivery were higher among those respondents who had 8 or more ANC contacts (OR = 3.39, p < 0.001, 95% CI: 2.26, 5.08), and those who had 4–7 ANC contacts (OR = 1.72, p < 0.001, 95% CI: 1.48, 1.99) as compared to those with less than 4 ANC contacts. About 26% of the respondents had any exposure to an ASHA worker. After controlling for ANC contacts, these respondents had three times the odds of institutional delivery (OR = 3.04, p < 0.001, 95% CI: 2.37, 3.89) compared to those who had no exposure to ASHA workers. Further, several sociodemographic variables were associated with institutional delivery. While age of spouse, age at marriage, level of education and urban residence were positively associated with institutional delivery; age of respondent and number of children were inversely associated with institutional delivery.ConclusionsBoth frequency of ANC contacts and exposure to ASHA worker independently emerge as important determinants of institutional delivery. Furthermore, ASHA workers may have a crucial role in promoting antenatal care, thereby strengthening the association between ANC contacts and institutional delivery.
Highlights
India has focused on incentivizing institutional delivery and introducing the Accredited Social Health Activist (ASHA) worker as a key strategy to improve maternal health outcomes
20% had any exposure to an ASHA worker and 4% had eight or more antenatal care (ANC) contacts
We found that frequency of ANC contacts and exposure to ASHA worker are negatively, significantly correlated (χ2 = 119.84, p < 0.001)
Summary
India has focused on incentivizing institutional delivery and introducing the ASHA worker as a key strategy to improve maternal health outcomes. Quality care during pregnancy and through child birth is associated with improved maternal and child health outcomes [4, 5]. Evidence shows that delivery at a health facility assisted by skilled birth attendants and with access to emergency obstetric care is crucial to reducing maternal deaths [6, 7]. While the implementation of government programs aimed at improving maternal and child health outcomes have been associated with increased utilization of antenatal care and in-facility births in India [8]; there still exist considerable socio-economic inequities in access to institutional delivery services [9, 10]
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