Thind Amardeep, Mohani Amir, Banerjee Kaberi, Hagigi Fred
Department of Family Medicine, Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada.
BMC Public Health. 2008 Jan 24;8:29. doi: 10.1186/1471-2458-8-29.
In 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.
Cross sectional analyses of the National Family Health Survey - 2 dataset.
Maharashtra 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.
A 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.
As 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.
为降低孕产妇死亡率，印度政府加大了对机构分娩的投入。我们评估了印度西部某邦家庭分娩、私立和公立部门分娩利用情况的决定因素。
对全国家庭健康调查-2数据集进行横断面分析。
马哈拉施特拉邦。该数据集样本为5391名年龄在15至49岁之间的已婚女性。提取了最近一次分娩的数据（n = 1510）并用于分析。概念框架为安德森行为模型。进行多项逻辑回归分析以评估易患因素、促成因素和需求因素与家庭、公立或私立部门分娩利用情况之间的关联。
大多数产妇在家分娩（n = 559，37%）；私立和公立机构分娩分别占32%（n = 493）和31%（n = 454）。在家庭分娩与公立机构分娩的选择中，生育次序较高的女性以及居住在农村地区的女性在家分娩的几率更高，而产妇年龄增加、媒体曝光度增加以及产前检查超过三次与在公立机构分娩的几率增加相关。产妇和父亲的教育程度、种姓/部落地位以及媒体曝光度是公立与私立机构分娩选择的统计学显著预测因素。
随着印度经济持续增长，私立部门将继续扩张。鉴于家庭在医疗方面的高额支出，政府需要推动保险计划或提供补助以防止贫困。政府还需要加强公共部门，使其能够回归作为安全网的使命。
