Institutional deliveries in India’s nine low performing states: levels, determinants and accessibility

Abstract

Background Despite the implementation of several national-level interventions, institutional delivery coverage remains unsatisfactory in India’s low performing states (LPS), leading to a high burden of maternal mortality. Objective This study investigates the levels, differentials, and determinants of institutional deliveries in LPS of India. The study also delineates a holistic understanding of barriers to delivery at health facilities and the utilization of the Janani Suraksha Yojana (JSY) specifically designed to improve maternal and child health of disadvantaged communities. Methods A cross-sectional study was conducted using data from the National Family Health Survey (NFHS)-4, 2015–16. The study was carried out over India’s nine LPS utilizing 112,518 women who had a living child in the past five years preceding the survey. Bivariate and multivariate regression analysis techniques were used to yield findings. Results Of the study sample, nearly three-quarters (74%) of women delivered in a health institution in the study area, with the majority delivered in public health facilities. The multivariate analysis indicates that women who lived in rural areas, belonged to disadvantaged social groups (e.g. Scheduled caste/tribes and Muslims), and those who married early (before 18 years) were less likely to utilize institutional delivery services. On the other hand, women’s education, household wealth, and exposure to mass media were found to be strong facilitators of delivering in a health facility. Meeting with a community health worker (CHW) during pregnancy emerged as an important predictor of institutional delivery in our study. Further, interaction analysis shows that women who reported the distance was a ‘big problem’ in accessing medical care had significantly lower odds of delivering at a health facility. Conclusions The study suggests emphasizing the quality of in-facility maternal care and awareness about the importance of reproductive health. Furthermore, strengthening sub-national policies specifically in underperforming states is imperative to improve institutional delivery coverage.

Facilitators & barriers for effective implementation of Dakshata programme to improve the quality of institutional maternal care in tribal blocks of Maharashtra

“…A part of the efforts focussed on promoting institutional deliveries through Janani Suraksha Yojana and Janani Shishu Suraksha Karyakram . As per recent studies, about 80 per cent of mothers in India deliver at a health facility 2 - 4 . However, the rise in institutional deliveries has not been commensurate with the fall in maternal deaths.…”

mHealth learning tool for skilled birth attendants: scaling the Safe Delivery App in India

“…4 As a result, India observed a substantial increase from 41% in 2005 to 06%-79% in 2015-2016 in institutional deliveries from 2004 to 2014. 6 Although India Open access has made considerable progress in reducing maternal mortality over the past years, it remains high in low performing states (161 deaths per 100 000 live births). 6 In 2013, the GoI launched 'A Strategic Approach to Reproductive, Maternal, Newborn, Child Plus Adolescent Health (RMNCH+A)' which focused on the continuum of care and emphasised the need for equitable access to high-quality care.…”

“…6 Although India Open access has made considerable progress in reducing maternal mortality over the past years, it remains high in low performing states (161 deaths per 100 000 live births). 6 In 2013, the GoI launched 'A Strategic Approach to Reproductive, Maternal, Newborn, Child Plus Adolescent Health (RMNCH+A)' which focused on the continuum of care and emphasised the need for equitable access to high-quality care. The GoI identified 184 high priority districts for critical RMNCH+A interventions and developed a framework to provide technical support to state and district health departments with support from development partners.…”

“…They also established and strengthened the public health infrastructure and resources to provide essential and emergency obstetric and newborn care services and strengthened referral linkages between facilities and communities through ambulance services 4. As a result, India observed a substantial increase from 41% in 2005 to 06%–79% in 2015–2016 in institutional deliveries from 2004 to 2014 6. Although India has made considerable progress in reducing maternal mortality over the past years, it remains high in low performing states (161 deaths per 100 000 live births) 6.…”

Intrapartum respectful maternity care practices and its barriers in Eastern India

“…[ 1 ] The Indian government is making tremendous efforts by implementing various programs to promote institutional delivery for poor pregnant women by ensuring cost-effective skilled health care professionals to reduce maternal and infant mortalities and morbidities. [ 2 ] However, recent evidence suggests that these interventions did not have the desired impacts, with many maternal deaths, especially in poor-performing states, highlighting the need to improve the quality of care for institutional births. [ 3 ] Despite the international laws upholding the pregnant women’s right to respectful maternal care (RMC), there are numerous reports of abuse, mistreatment, and neglect of the pregnant woman during the entire pregnancy cycle, especially in low- and middle-income countries (LMIC).…”