Abstract
BackgroundDespite a significant increase in the skilled birth assisted (SBA) deliveries in India, there are huge gaps in availing maternity care services across social gradients - particularly across states and regions. Therefore, this study applies the spatial-regression model to examine the spatial distribution of SBA across districts of India. Furthermore, the study tries to understand the spatially associated population characteristics that influence the low coverage of SBA across districts of India and its regions.MethodsThe study used national representative cross-sectional survey data obtained from the fourth round of National Family Health Survey, conducted in 2015-16. The effective sample size was 259,469 for the analysis. Moran’s I statistics and bivariate Local Indicator for Spatial Association maps were used to understand spatial dependence and clustering of deliveries conducted by SBA coverage in districts of India. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of deliveries conducted by SBA.ResultsMoran’s I value for SBA among women was 0.54, which represents a high spatial auto-correlation of deliveries conducted by SBA over 640 districts of India. There were 145 hotspots for deliveries conducted by SBA among women in India, which includes almost the entire southern part of India. The spatial error model revealed that with a 10% increase in exposure to mass media in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Interestingly, also with the 10% increase in the four or more antenatal care (ANC) in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Again, if there was a 10% increase of women with first birth order in a particular district, then the deliveries conducted by SBA significantly increased by 6.1%. If the district experienced an increase of 10% household as female-headed, then the deliveries conducted by SBA significantly increased by 1.4%.ConclusionThe present study highlights the important role of ANC visits, mass media exposure, education, female household headship that augment the use of an SBA for delivery. Attention should be given in promoting regular ANC visits and strengthening women’s education.
Highlights
Despite a significant increase in the skilled birth assisted (SBA) deliveries in India, there are huge gaps in availing maternity care services across social gradients - across states and regions
The highest bivariate Moran’s I (SBA vs explanatory variable) value was for SBA vs four or more antenatal care (ANC) (0.49) followed by SBA vs women from poor socio-economic status (− 0.43) and SBA vs first birth order (0.43)
When we look into the results of bivariate Local Indicator of Spatial Association (LISA) maps for delivery conducted by SBAs by background characteristics of women in India, we find that even among the cold spots, states like Uttar Pradesh and Bihar do not perform well
Summary
Despite a significant increase in the skilled birth assisted (SBA) deliveries in India, there are huge gaps in availing maternity care services across social gradients - across states and regions. The MMR has declined from 130 in 2014-2016 to 122 in 2015-17 in India, this decline has been observed to be most significant in the Empowered Action Group (EAGs) states and Assam ( known as low performing states) from 188 to 175 per 1,00,000 live births. Among the Southern states (known as high performing states), the decline has been from 77 to 72 [4] This decline is highly linked with increased use of essential health care and quality of care services such as ante-natal care, institutional delivery and skilled birth attendants (SBA). Earlier studies have clearly shown that unskilled birth attendance and delivery at home are associated with high infant and maternal mortality and morbidity [5,6,7,8]
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