Yasobant Sandul, Shewade Hemant Deepak, Vora Kranti Suresh, Annerstedt Kristi Sidney, Isaakidis Petros, Dholakia Nishith B, Mavalankar Dileep V
Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India.
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India.
BMC Health Serv Res. 2017 Apr 25;17(1):302. doi: 10.1186/s12913-017-2256-6.
In Gujarat, India, a state led public private partnership scheme to promote facility birth named Chiranjeevi Yojana (CY) was implemented in 2005. Institutional birth is provided free of cost at accredited private health facilities to women from socially disadvantaged groups (eligible women). CY has contributed in increasing facility birth and providing substantially subsidized (but not totally free) birth care; however, the retention of mothers in this scheme in subsequent child birth is unknown. Therefore, we conducted a study aimed to determine the effect of previous utilization of the scheme and previous out of pocket expenditure on subsequent child birth among multiparous eligible women in Gujarat.
This was a retrospective cohort study of multiparous eligible women (after excluding abortions and births at public facility). A structured questionnaire was administered by trained research assistant to those with recent delivery between Jan and Jul 2013. Outcome of interest was CY utilization in subsequent child birth (Jan-Jul 2013). Explanatory variables included socio-demographic characteristics (including category of eligibility), pregnancy related characteristics in previous child birth, before Jan 2013, (including CY utilization, out of pocket expenditure) and type of child birth in subsequent birth. A poisson regression model was used to assess the association of factors with CY utilization in subsequent child birth.
Of 997 multiparous eligible women, 289 (29%) utilized and 708 (71%) did not utilize CY in their previous child birth. Of those who utilized CY (n = 289), 182 (63%) subsequently utilized CY and 33 (11%) gave birth at home; whereas those who did not utilize CY (n = 708) had four times higher risk (40% vs. 11%) of subsequent child birth at home. In multivariable models, previous utilization of the scheme was significantly associated with subsequent utilization (adjusted Relative Risk (aRR): 2.7; 95% CI: 2.2-3.3), however previous out of pocket expenditure was not found to be associated with retention in the CY scheme.
Women with previous CY utilization were largely retained; therefore, steps to increase uptake of CY are expected to increase retention of mothers within CY in their subsequent child birth. To understand the reasons for subsequent child birth at home despite previous CY utilization and previous zero/minimal out of pocket expenditure, future research in the form of systematic qualitative enquiry is recommended.
在印度古吉拉特邦，一项由政府主导的公私合作促进机构分娩的计划——奇兰吉维计划（CY）于2005年实施。社会弱势群体（符合条件的妇女）在经认可的私立医疗机构可免费享受机构分娩服务。CY计划有助于增加机构分娩数量，并提供大幅补贴（但并非完全免费）的分娩护理；然而，该计划中产妇在后续分娩中的留存情况尚不清楚。因此，我们开展了一项研究，旨在确定古吉拉特邦多胎符合条件的妇女此前参与该计划的情况及此前的自付费用对其后续分娩的影响。
这是一项针对多胎符合条件妇女（不包括在公立医院的流产和分娩情况）的回顾性队列研究。由经过培训的研究助理向2013年1月至7月期间近期分娩的妇女发放结构化问卷。研究的关注结果是后续分娩（2013年1月至7月）中CY计划的使用情况。解释变量包括社会人口学特征（包括资格类别）、2013年1月之前前次分娩的妊娠相关特征（包括CY计划的使用情况、自付费用）以及后续分娩的类型。采用泊松回归模型评估各因素与后续分娩中CY计划使用情况之间的关联。
在997名多胎符合条件的妇女中，289名（29%）在前次分娩中使用了CY计划，708名（71%）未使用。在使用CY计划的妇女中（n = 289），182名（63%）在后续分娩中继续使用CY计划，33名（11%）在家分娩；而未使用CY计划的妇女（n = 708）后续在家分娩的风险高出四倍（40%对11%）。在多变量模型中，此前参与该计划与后续使用情况显著相关（调整后相对风险（aRR）：2.7；95%置信区间：2.2 - 3.3），然而，此前的自付费用与CY计划中的留存情况无关。
此前使用过CY计划的妇女大多继续参与该计划；因此，预计增加CY计划的参与度的措施将提高产妇在后续分娩中继续参与CY计划的比例。为了解尽管此前使用过CY计划且此前自付费用为零/极少，但仍有后续在家分娩的原因，建议开展系统定性调查形式的未来研究。
