Abstract
BackgroundMaternity care in South Asia is available in both public and private sectors. Using data from demographic surveillance sites in Bangladesh, Nepal and rural and urban India, we aimed to compare institutional delivery rates and public-private share.MethodsWe used records of maternity care collected in socio-economically disadvantaged communities between 2005 and 2011. Institutional delivery was summarized by four potential determinants: household asset index, maternal schooling, maternal age, and parity. We developed logistic regression models for private sector institutional delivery with these as independent covariates.ResultsThe data described 52 750 deliveries. Institutional delivery proportion varied and there were differences in public-private split. In Bangladesh and urban India, the proportion of deliveries in the private sector increased with wealth, maternal education, and age. The opposite was observed in rural India and Nepal.ConclusionsThe proportion of institutional delivery increased with economic status and education. The choice of sector is more complex and provision and perceived quality of public sector services is likely to play a role. Choices for safe maternity are influenced by accessibility, quantity and perceived quality of care. Along with data linkage between private and public sectors, increased regulation should be part of the development of the pluralistic healthcare systems that characterize south Asia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1069-7) contains supplementary material, which is available to authorized users.
Highlights
Maternity care in South Asia is available in both public and private sectors
Adolescent pregnancy appeared more common in rural Nepal, and women had their pregnancies later in urban India
The opposite was observed in rural India and, perhaps, in rural Nepal, in which greater proportions of poorer, less educated, multigravid women delivered at private rather than public facilities
Summary
Maternity care in South Asia is available in both public and private sectors. Using data from demographic surveillance sites in Bangladesh, Nepal and rural and urban India, we aimed to compare institutional delivery rates and public-private share. The last two decades have seen considerable increases in institutional delivery rates in South Asia: from 4 to 29 % in Bangladesh between 1993 and 2011, from 26 to 79 % in India between 1992 and 2011, and from 8 to 35 % in Nepal between 1996 and 2011 [3,4,5,6,7,8]. In Bangladesh (2011), 49 % of urban women delivered in a health facility, compared with 23 % of rural women [4]. Comparative proportions were 71 and 31 % in India, and 52 and 15 % in Nepal [9]
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