Wilcox Meredith L, Krupp Karl, Niranjankumar Bhavana, Srinivas Vijaya, Jaykrishna Poornima, Arun Anjali, Madhivanan Purnima
Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, University Park, AHC5-477, Miami FL 33199, USA.
Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India; Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.
Midwifery. 2016 Mar;34:245-252. doi: 10.1016/j.midw.2015.11.001. Epub 2015 Nov 10.
India accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India.
Between January 2009 and 2011, 1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth.
The median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR]=7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p<0.001) and private institutions (AOR=3.00, p<0.001).
As a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status.
在全球新生儿出生首日死亡案例中，印度占了近三分之一。尽管印度在增加机构分娩方面取得了显著进展，但仍有大量农村妇女选择在家分娩。本研究旨在确定印度迈索尔农村地区近期分娩妇女的分娩地点相关因素。
2009年1月至2011年期间，1675名参与迈索尔地区前瞻性队列研究的农村孕妇完成了由访员管理的关于孕产妇护理服务的问卷调查。原始研究获得了维克拉姆医院和佛罗里达国际大学机构审查委员会的伦理批准。对分娩后成功随访的1654名（99%）妇女进行逻辑回归分析，以确定与分娩地点相关的因素。
这些妇女的年龄中位数为20岁；大多数人受过教育（87%）、低收入（52%）且多产（56%）。在家分娩的比例较低（4%）。在家分娩的妇女中有一半没有充分规划交通（55%）、财务（48%）或由专业人员接生（55%）。与在公立医院（调整后的优势比[AOR]=7.83，p<0.001）和私立机构（AOR=7.05，p<0.001）分娩相比，经产妇在家分娩的几率更高。接受≥4次产前检查的妇女在公立医院（AOR=2.53，p=0.036）和私立机构（AOR=3.58，p=0.010）分娩的几率更高。分娩准备得分较高的妇女在公立医院（AOR=2.53，p<0.001）和私立机构（AOR=3.00，p<0.001）分娩的几率也更高。
作为降低新生儿死亡率的一种手段，印度及类似人群的孕产妇健康干预措施应侧重于提高农村妇女尤其是社会经济地位较低妇女的分娩准备程度和机构分娩比例。
