Public Health Consultant, London, UK.
Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India.
Glob Health Action. 2021 Jan 1;14(1):2001145. doi: 10.1080/16549716.2021.2001145.
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.
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 (JSY) specifically designed to improve maternal and child health of disadvantaged communities.
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.
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.
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.
尽管印度实施了多项国家级干预措施，但在表现不佳的邦（LPS），产妇住院分娩率仍不理想，导致孕产妇死亡率居高不下。
本研究旨在调查印度 LPS 地区产妇住院分娩率的水平、差异和决定因素。此外，本研究还全面了解了在卫生机构分娩的障碍以及专门为改善弱势社区母婴健康而设计的（JSY）的利用情况。
本研究使用了 2015-16 年全国家庭健康调查（NFHS-4）的数据，采用了横断面研究方法。该研究在印度的 9 个 LPS 地区进行，共有 112518 名在调查前五年内生育过活产儿的妇女参与。采用了单变量和多变量回归分析技术来得出研究结果。
在研究样本中，近四分之三（74%）的妇女在研究地区的医疗机构分娩，其中大部分在公立医疗机构分娩。多变量分析表明，居住在农村地区、属于弱势社会群体（如在册种姓/部落和穆斯林）以及早婚（18 岁之前）的妇女较少利用住院分娩服务。另一方面，妇女的教育程度、家庭财富和接触大众媒体被发现是在医疗机构分娩的有力促进因素。在怀孕期间与社区卫生工作者（CHW）会面被认为是本研究中产妇住院分娩的一个重要预测因素。此外，交互分析表明，报告医疗服务获取存在“大问题”的妇女在医疗机构分娩的可能性显著降低。
本研究表明，应强调医疗机构内产妇护理的质量和对生殖健康重要性的认识。此外，加强次国家级政策，特别是在表现不佳的邦，对于提高产妇住院分娩率至关重要。
