Abstract

BackgroundThis paper discusses length of stay (LOS) following childbirth as an indicator of quality of postnatal care in health institutions. This research aims to describe LOS according to both vaginal and cesarean deliveries in public and private health care institutions in India, and to identify any association of LOS with postnatal care and post-delivery complications.MethodsWe use recently released nationally-representative data from the National Family Health Survey-4 (2015–16) and apply the Cox proportional hazard model to determine the factors associated with LOS at the health facility after childbirth during a five-year period preceding the survey.ResultsOverall, the average LOS after childbirth is 3.4 days; 2.1 days for vaginal deliveries and 8.6 days for cesarean section (CS) deliveries. Strikingly, half of the women are discharged within 48 h. Women who give birth in private hospitals have a more prolonged stay than those who give birth in public health facilities. For vaginal birth in public hospitals, one-fourth of the women are discharged with insufficient LOS as against only 19.2% women in private hospitals. LOS is significantly related to the cost of delivery only in the case of private facilities. Uneducated women belonging to lower wealth quintile households and those living in rural areas stay for a shorter duration for vaginal deliveries but for a longer duration in case of cesarean deliveries. Women who get four or more antenatal check-ups (ANC) done have a longer stay, while those who receive benefits under the Janani Suraksha Yojna (JSY) have a shorter stay. Another key finding is that women who are discharged on the same day report lower levels of postnatal care and a higher proportion of post-delivery complications.ConclusionThe study concludes that early discharge has a negative association with maternal health outcomes, which has important program implications. Therefore, it is essential to maintain an adequate LOS at a facility after childbirth. We recommend that government programs should strengthen the JSY scheme not only to improve delivery care, but also to provide effective postnatal care by promoting sufficient LOS at facilities.

Highlights

  • This paper discusses length of stay (LOS) following childbirth as an indicator of quality of postnatal care in health institutions

  • In the case of cesarean deliveries, women admitted in public facilities stay for a longer time than those admitted in private health facilities

  • A higher proportion of women who deliver in a public health facility are discharged within 2 days of the delivery as compared to those who deliver in a private health facility

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Summary

Introduction

This paper discusses length of stay (LOS) following childbirth as an indicator of quality of postnatal care in health institutions. The JSY program encourages institutional births by providing cash incentives to pregnant women and Accredited Social Health Activists (ASHAs). This has led to a reduction in the MMR, especially in states with a high maternal mortality. Length of stay after childbirth is an important factor influencing MMR, but it has not increased to the same degree as institutional birth. 12% of the women who stay for 3 days in the facility report high fever (within 2 months) after vaginal delivery as compared to 19% of such women who are discharged on the same day. The highest reporting of PPH is among women who stay for 4 days in public facilities and for eight or more days in private facilities. The highest proportion of PPH (25% or more) is among women who have a vaginal or public health delivery and stay for 4 days and among those who have a cesarean or private health delivery and stay for 8 or more days

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