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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2010

Open Access 01-12-2010 | Research article

Institutional delivery in rural India: the relative importance of accessibility and economic status

Authors: Amy J Kesterton, John Cleland, Andy Sloggett, Carine Ronsmans

Published in: BMC Pregnancy and Childbirth | Issue 1/2010

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Abstract

Background

Skilled attendance at delivery is an important indicator in monitoring progress towards Millennium Development Goal 5 to reduce the maternal mortality ratio by three quarters between 1990 and 2015. In addition to professional attention, it is important that mothers deliver their babies in an appropriate setting, where life saving equipment and hygienic conditions can also help reduce the risk of complications that may cause death or illness to mother and child. Over the past decade interest has grown in examining influences on care-seeking behavior and this study investigates the determinants of place of delivery in rural India, with a particular focus on assessing the relative importance of community access and economic status.

Methods

A descriptive analysis of trends in place of delivery using data from two national representative sample surveys in 1992 and 1998 is followed by a two-level (child/mother and community) random-effects logistical regression model using the second survey to investigate the determinants.

Results

In this investigation of institutional care seeking for child birth in rural India, economic status emerges as a more crucial determinant than access. Economic status is also the strongest influence on the choice between a private-for-profit or public facility amongst institutional births.

Conclusion

Greater availability of obstetric services will not alone solve the problem of low institutional delivery rates. This is particularly true for the use of private-for-profit institutions, in which the distance to services does not have a significant adjusted effect. In the light of these findings a focus on increasing demand for existing services seems the most rational action. In particular, financial constraints need to be addressed, and results support current trials of demand side financing in India.
Appendix
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Literature
1.
2.
Campbell OM, Graham WJ, on behalf of The Lancet Maternal Survival Series steering group: Strategies for reducing maternal mortality: getting on with what works. The Lancet. 2006, 368 (9543): 1284-1299. 10.1016/S0140-6736(06)69381-1.CrossRef
3.
Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med. 1994, 38 (8): 1089-1110. 10.1016/0277-9536(94)90226-7.CrossRef
4.
Timyan J: Access to care; More than a problem of distance. The Health of Women: A Global Perspective. Edited by: Koblinsky M, Timyan, Boulder M. 1993, San Francisco and Oxford: Westview Press
5.
Celik Y, Hotchkiss D: The socio-economic determinants of maternal health care utilisation in Turkey. Soc Sci Med. 2000, 50 (12): 1797-1806. 10.1016/S0277-9536(99)00418-9.CrossRefPubMed
6.
Falkingham J: Inequality and changes in women's use of maternal health care services in Tajikstan. Stud Fam Plann. 2003, 34 (1): 1783-1789. 10.1111/j.1728-4465.2003.00032.x.CrossRef
7.
Bhatia JC, Cleland J: Determinants of maternal care in a region of South India. Health Transit Rev. 1995, 5: 127-142.
8.
Navaneetham K, Dharmalingam A: Utilization of Maternal Health Care Services in Southern India. Soc Sci Med. 2002, 55 (10): 1849-1869. 10.1016/S0277-9536(01)00313-6.CrossRefPubMed
9.
Gwatkin D, Bhuiya A, Victora C: Making health systems more equitable. The Lancet. 2004, 364: 1273-1280. 10.1016/S0140-6736(04)17145-6.CrossRef
10.
Ensor T, Witter S: Provider payment systems. Health Economics for Developing Countries: A Practical Guide. Edited by: Witter S, Ensor T, Jowett M. 2000, London: MacMillan
11.
Borghi J: What is the cost of Maternal Health Care and how can it be financed?. Studies in Health Service Organisation and Policy. 2001, 17: 247-296.
12.
Balaji R, Dilip T, Duggal R: Utilisation of and expenditure on Delivery Care Services: Some Observations from Nashik District Maharshtra. Regional Health Forum WHO-South-East Asia Region. 2003
13.
Das NP, Mishra VK, Saha PK: Does Community Access Affect the Use of Health and Family Welfare Services in Rural India?. National Family Health Survey Subject Reports No. 18. 2001, Mumbai: International Institute for Population Sciences and Honolulu: East-West Center
14.
Vora CS, Mavalankar DV, Ramani KV, Upadhyaya M, Sharma B, Iyengar S, Gupta V, Iyengar K: Maternal Health Situation in India: A Case Study. J Health Popul Nutr. 2009, 27 (2): 184-201. 10.3329/jhpn.v27i2.3363.CrossRefPubMedPubMedCentral
15.
Ronsmans C, Graham WJ, on behalf of the Lancet Maternal Survival Series Steering Group: Maternal mortality: who, when, where and why. Lancet. 2006, 368: 1189-1200. 10.1016/S0140-6736(06)69380-X.CrossRefPubMed
16.
Sawhney N: Management of family welfare programmes in Uttar Pradesh: infrastructure utilisation, quality of services, supervision and MIS. Family Planning and MCH in Uttar Pradesh (A Review of Studies). Edited by: Premi M. 1993, New Delhi: Indian Association for the Study of Population, 50-67.
17.
Elo IT: Utilisation of maternal health-care services in Peru: the role of women's education. Health Transit Rev. 1992, 2 (1): 49-69.PubMed
18.
Kumar RM, Singh M, Kaur M: Impact of health centre availability on utilisation of maternity care and pregnancy outcome in a rural area of Haryana. J Indian Med Assoc. 1997, 95 (8): 448-50.PubMed
19.
Chowdhury M, Ronsmans C, Killewo J, Anwar I, Gausia K, Das-Gupta S, Blum LS, Dieltiens G, Marshall T, Saha S, Borghi J: Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study. The Lancet. 2006, 367 (9507): 327-32. 10.1016/S0140-6736(06)68070-7.CrossRef
20.
Dadhich J, Paul V: State of India's newborns. 2004, New Delhi: National Neonatology Forum and Washington DC: Save the Children
21.
Pinel A, Islam QM, Villeneuve P, Lakshminarayanan R: Strategies for maternal mortality reduction. The Lancet. 2007, 369 (9561): 557-558. 10.1016/S0140-6736(07)60271-2.CrossRef
22.
Kim Choe M, Chen J: Potential for Reducing Child and Maternal Mortality through Reproductive and Child Health Intervention Programmes: An Illustrative Case Study from India. Asia Pac Popul J. 2006, 21 (1): 13-39.
23.
Chatterjee P: India's efforts to boost neonatal survival. The Lancet. 2006, 368: 1055-10.1016/S0140-6736(06)69426-9.CrossRef
24.
Langford I, Leyland AH, Rasbash J, Goldstein H: Multilevel modelling of the geographical distributions of diseases. J R Stat Soc. 1999, 48: 253-268. 10.1111/1467-9876.00153.CrossRef
25.
Merlo J: Multilevel analytical approaches in social epidemiology: measures of health variation compared with traditional measures of association. J Epidemiol Community Health. 2003, 57: 550-552. 10.1136/jech.57.8.550.CrossRefPubMedPubMedCentral
26.
Sakamoto Y, Ishiguro M, Kitagawa G: Akaike Information Criterion Statistics. 1986, Dordrecht, Netherlands: Reidel
27.
Filmer D, Pritchett LH: Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India. Demography. 2001, 38 (1): 115-132.PubMed
28.
Houweling T, Kunst A, Mackenbach J: Measuring health inequality among children in developing countries: does the choice of the indicator of economic status matter?. Int J Equity Health. 2003, 2: 1-12. 10.1186/1475-9276-2-8.CrossRef
29.
McNay K, Arokiasamy P, Cassen P: Why are uneducated women in India using contraception? A multi-level analysis. Population studies. 2003, 57 (1): 21-40. 10.1080/0032472032000061703.CrossRefPubMed
30.
International Institute for Population Sciences (IIPS): National Family Health Survey (NFHS-3). National Fact Sheet India 2005-6 (Provisional Data). 2007, Mumbai, India
31.
Mavalankar D, Vora K, Prakasamma M: Achieving Millennium Development Goal 5: is India serious?. Bulletin of The World Health Organization. 2008, 86 (4): 243-10.2471/BLT.07.048454.CrossRefPubMedPubMedCentral
32.
Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, Marchal B, De Brouwere V, van Lerberghe W, on behalf of The Lancet Maternal Survival Series steering group: Going to scale with professional skilled care. The Lancet. 2006, 368 (9544): 1377-1386. 10.1016/S0140-6736(06)69382-3.CrossRef
33.
Borghi J, Ensor T, Somanathan A, Lissner C, Mills A, on behalf of the Lancet Maternal Survival Series steering group: Mobilising financial resources for maternal health. The Lancet. 2006, 368 (9545): 1457-1465. 10.1016/S0140-6736(06)69383-5.CrossRef
34.
Govindasamy P, Ramesh BM: Maternal Education and the Utilisation of Maternal and Child Health Services in India. National Family Health Survey Subject Report, No. 5. 1997, Calverton, Maryland: Macro International and Mumbai: International Institute for Population Sciences
35.
Mishra V, Retherford R: The Effect of Antenatal Care on Professional Assistance at Delivery in Rural India. DHS Working Paper, India. 2006
36.
Sugathan K, Mishra V, Retherford R: Promoting Institutional Deliveries in Rural India: The Role of Antenatal-Care Services. 2001, Mumbai, India: International Institute for Population Sciences, and Honolulu: East-West Center, Population and Health Studies, USA
37.
Indian Ministry of Health and Family Welfare: Janani Suraksha Yojana: features & frequency asked ques¬tions and answers. New Delhi, India. 2006
38.
Stephenson R, Tsui A: Contextual influences on reproductive wellness in Northern India. Am J Public Health. 2002, 93 (11): 1820-1829. 10.2105/AJPH.93.11.1820.CrossRef
39.
Matthews Z, Ramakrishna J, Mahendra S, Kilaru A, Ganapathy S: Birth-rights and rituals in rural south India: Care-seeking in the intra-partum period. J Biosoc Sci. 2005, 37 (4): 385-411. 10.1017/S0021932004006911.CrossRefPubMed
40.
Ray SK, Mukhopadhyay BB, Das R, Ganguly MM, Mandal A, Roy SC: Extent of utilisation of maternal health care services of PHC by families of a rural area. Indian J Public Health. 1984, 28 (3): 122-7.PubMed
41.
ICMR Indian Council of Medical Research (ICMR): Evaluation of quality of family welfare services at primary health centre level: An ICMR Task Force Study, India. 1991
42.
Chatterjee M: Indian women: Their health and economic productivity. 1990, Washington DC: The World Bank
43.
Basu A: Cultural influences on health care use: two regional groups in India. Stud Fam Plann. 1990, 21 (5): 276-286. 10.2307/1966507.CrossRef
Metadata
Title
Institutional delivery in rural India: the relative importance of accessibility and economic status
Authors
Amy J Kesterton
John Cleland
Andy Sloggett
Carine Ronsmans
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2010
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-10-30

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