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

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 determinant...

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Autores principales: Saha, Ria, Paul, Pintu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8682830/
https://www.ncbi.nlm.nih.gov/pubmed/34914883
http://dx.doi.org/10.1080/16549716.2021.2001145
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author Saha, Ria
Paul, Pintu
author_facet Saha, Ria
Paul, Pintu
author_sort Saha, Ria
collection PubMed
description 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.
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spelling pubmed-86828302021-12-18 Institutional deliveries in India’s nine low performing states: levels, determinants and accessibility Saha, Ria Paul, Pintu Glob Health Action Research Article 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. Taylor & Francis 2021-12-16 /pmc/articles/PMC8682830/ /pubmed/34914883 http://dx.doi.org/10.1080/16549716.2021.2001145 Text en © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Saha, Ria
Paul, Pintu
Institutional deliveries in India’s nine low performing states: levels, determinants and accessibility
title Institutional deliveries in India’s nine low performing states: levels, determinants and accessibility
title_full Institutional deliveries in India’s nine low performing states: levels, determinants and accessibility
title_fullStr Institutional deliveries in India’s nine low performing states: levels, determinants and accessibility
title_full_unstemmed Institutional deliveries in India’s nine low performing states: levels, determinants and accessibility
title_short Institutional deliveries in India’s nine low performing states: levels, determinants and accessibility
title_sort institutional deliveries in india’s nine low performing states: levels, determinants and accessibility
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8682830/
https://www.ncbi.nlm.nih.gov/pubmed/34914883
http://dx.doi.org/10.1080/16549716.2021.2001145
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