Are marginalized women being left behind? A population-based study of institutional deliveries in Karnataka, India

Abstract

BackgroundWhile India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations.MethodsA population-based survey was carried out among 16 randomly selected rural villages in rural Mysore District in Karnataka, India between August and September 2008. All households in selected villages were enumerated and women with children 6 years of age or younger underwent an interviewer-administered questionnaire on antenatal care and institutional delivery.ResultsInstitutional deliveries in rural areas of Mysore District increased from 51% to 70% between 2002 and 2008. While increasing numbers of women were accessing antenatal care and delivering in hospitals, large disparities were found in uptake of these services among different castes. Mothers belonging to general castes were almost twice as likely to have an institutional birth as compared to scheduled castes and tribes. Mothers belonging to other backward caste or general castes had 1.8 times higher odds (95% CI: 1.21, 2.89) of having an institutional delivery as compared to scheduled castes and tribes. In multivariable analysis, which adjusted for inter- and intra-village variance, Below Poverty Line status, caste, and receiving antenatal care were all associated with institutional delivery.ConclusionThe results of the study suggest that while the Indian Government has made significant progress in increasing antenatal care and institutional deliveries among rural populations, further success in lowering maternal mortality will likely hinge on the success of NRHM programs focused on serving marginalized groups. Health interventions which target SC/ST may also have to address both perceived and actual stigma and discrimination, in addition to providing needed services. Strategies for overcoming these barriers may include sensitization of healthcare workers, targeted health education and outreach, and culturally appropriate community-level interventions. Addressing the needs of these communities will be critical to achieving Millennium Development Goal Five by 2015.

Utilization of institutional delivery services across successive births in India

“…Muslim and scheduled caste women were less likely to deliver their three most recent births in an institution. For the other two recent births, religion was not a significant predictor -a finding that is consistent with earlier studies (Mekonnen and Mekonnen, 2002;Saroha, Altarac, and Sibley, 2008). The observation that Muslim women sought less assistance from medical settings is likely to be attributed to their religious beliefs, cultural norms, and traditional practices (Ganle, 2015).…”

Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial’s Baseline Study Results

“…Similarly, rates of institutional deliveries were 96.0%, much higher than reported in 85.8% rural Karnataka and other studies [10]. These differences could be due to the variability in time demographic composition studied in these surveys.…”

“…Furthermore, higher antenatal care coverage has been associated with lower rates of antepartum stillbirth [12]. In this study, a vast majority (98.9%) of women reported at least one antenatal visit, which is higher than other studies in the state (93.4%) and 93.1% reported for rural Karnataka in the 2012–2013 DLHS-4 [9, 10]. Although the rates of antenatal reach in this study seem to be high, the frequency of visits per woman appear to be teetering on the edge of the World Health Organization’s (WHO) recommended four antenatal visits [15], ranging between an average of 2.7–7.6.…”

Users Experiences and Perceptions on Maternal Healthcare Services in Siaya County, Western Kenya: A Qualitative Study.

“…These deaths and injuries are partly due to inadequate utilization and poorquality maternal health care, -antenatal care, -skilled attendance at birth and postnatal care [5,6] and are entirely preventable through increased utilization of skilled maternal healthcare services [3]. In addition these mortality have been associated with maternal education, maternal age and autonomy of the mother [7][8][9]. Several studies have shown that skilled birth attendants during labour, delivery and the early postpartum period can reduce significant number of maternal and newborn deaths through provision of timely obstetric and newborn care [10].…”