Nair M, Ariana P, Webster P
Department of Public Health, University of Oxford, Oxford, UK.
Rural Remote Health. 2012;12:2311. Epub 2012 Nov 9.
Despite continuing efforts to promote skilled institutional delivery, eight women die every hour in India due to causes related to pregnancy and child birth. The objectives of this study were to assess the prevalence and the determinants of institutional delivery by skilled birth attendants in a rural population in Andhra Pradesh, India.
This cross-sectional study used data from 'Young Lives', a longitudinal study on childhood poverty, and the study population was a cohort of 1419 rural, economically deprived women (from the Young Lives study) in Andhra Pradesh, India. The data are from round-1 of Young Lives younger cohort recruited in 2002 and followed until 2015. The participation rate of households was 99.5%.
Prevalence of skilled institutional delivery was 36.8%. Women's education (odds ratio [OR] for secondary education 2.06; 95% confidence interval [95%CI] 1.33-3.19), desire to be pregnant (OR 1.89; 95% CI 1.12-3.22) and adequate prenatal care (OR 1.69; 95% CI 1.30-2.21) were found to be the positive determinants of skilled institutional delivery. High birth order (OR for second birth 0.44; 95% CI 0.32-0.60, OR for third birth 0.47; 95% CI 0.30-0.72 and OR for ≥fourth 0.47; 95% CI 0.27-0.81), schedule caste/schedule tribe social background (OR 0.70; 95% CI 0.53-0.93) and poor economic status of the household (OR for the poorest households 0.67; 95% CI 0.46-0.99) were negatively associated with skilled institutional delivery.
Despite existence of supporting schemes, the utilisation of skilled institutional delivery services was low in the study population. Educated women and women with adequate prenatal care who have a desired pregnancy were more likely to utilise health institutions and skilled delivery care. There is a need for integrated approaches through maternal health, family planning and education programs, and a focus on uneducated, poor women belonging to disadvantaged social groups.
尽管一直在努力推广熟练的机构分娩服务，但在印度，每小时仍有8名妇女因与怀孕和分娩相关的原因死亡。本研究的目的是评估印度安得拉邦农村人口中由熟练接生员进行机构分娩的患病率及其决定因素。
这项横断面研究使用了“儿童生活”（Young Lives）的数据，这是一项关于儿童贫困的纵向研究，研究人群是印度安得拉邦1419名农村经济贫困妇女（来自“儿童生活”研究）的队列。数据来自2002年招募的“儿童生活”较年轻队列的第一轮，并跟踪至2015年。家庭参与率为99.5%。
熟练机构分娩的患病率为36.8%。发现妇女的教育程度（中等教育的优势比[OR]为2.06；95%置信区间[95%CI]为1.33 - 3.19）、怀孕意愿（OR为1.89；95%CI为1.12 - 3.22）和充分的产前护理（OR为1.69；95%CI为1.30 - 2.21）是熟练机构分娩的积极决定因素。高出生顺序（第二次分娩的OR为0.44；95%CI为0.32 - 0.60，第三次分娩的OR为0.47；95%CI为0.30 - 0.72，第四次及以上分娩的OR为0.47；95%CI为0.27 - 0.81）、在册种姓/在册部落社会背景（OR为0.70；95%CI为0.53 - 0.93）以及家庭经济状况差（最贫困家庭的OR为0.67；95%CI为0.46 - 0.99）与熟练机构分娩呈负相关。
尽管存在支持计划，但研究人群中熟练机构分娩服务的利用率较低。受过教育的妇女以及有怀孕意愿且接受了充分产前护理的妇女更有可能利用医疗机构和熟练的分娩护理服务。需要通过孕产妇健康、计划生育和教育项目采取综合方法，并关注属于弱势群体的未受过教育的贫困妇女。
