Abstract
BackgroundIn order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state.MethodsCross sectional analyses of the National Family Health Survey – 2 dataset.SettingMaharashtra state. The dataset had a sample size of 5391 ever-married females between the ages of 15 to 49 years. Data were abstracted for the most recent birth (n = 1510) and these were used in the analyses. Conceptual framework was the Andersen Behavioral Model. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery.ResultsA majority delivered at home (n = 559, 37%); with private and public facility deliveries accounting for 32% (n = 493) and 31% (n = 454) respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery.ConclusionAs India's economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net.
Highlights
In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries
Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It needs to strengthen the public sector so that it can return to its mission of being the safety net
Despite the Registrar General reporting recently that the maternal mortality rate in India declined to 301 per 100,00 live births, India still accounts for the largest contribution to maternal deaths worldwide, related directly to or exacerbated by pregnancy. [1,2,3] Reducing the maternal mortality rate is a key goal of government, and this is enshrined in the National Population Policy, which aims
Summary
In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. [1,2,3] Reducing the maternal mortality rate is a key goal of government, and this is enshrined in the National Population Policy, which aims (page number not for citation purposes). Universal access to, and make available good quality maternal and child health care services".[4] One strategy advocated by the National Population Policy to reduce maternal mortality is to increase access to institutional deliveries in India. Institutional deliveries can occur at private or public facilities. Public facilities are usually owned and financed by the government, and while costs are usually minimal, available amenities often leave much to be desired. Private facilities are the most expensive, they are often perceived as having the best amenities and offering the best standard of care in India
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