Chandra Rakesh, Patel Jeetendra Kumar, Srivastava Sonal, Mukherjee Saradiya, Singh Aditya
School of Health Systems Studies, Tata Institute of Social Science, V.N. Purava Marg, Deonar, Mumbai, Mumbai, 400088, India.
Department of General & Applied Geography, Dr. Harisingh Gour Vishwavidyalaya, Sagar, M.P, India.
BMC Womens Health. 2025 Jul 3;25(1):301. doi: 10.1186/s12905-025-03819-8.
Non-institutional deliveries, defined as childbirth outside healthcare facilities, remain a significant global concern. It poses serious maternal and child health problems and significantly contributes to maternal and infant mortality. India witnessed a sustained decrease in non-institutional deliveries in thepast 20 years. However, the rate of decline has tapered recently while the country still has a sizeable number of women delivering out of the facility. To better understand the enduring proportions of non-institutional deliveries, this study preliminarily analyses its predictors. The prime objective of the study is to unravel the inequality in the prevalence of non-institutional deliveries and understand if they are unfairly concentrated among certain households in India. It also aims to provide policy-relevant insights into the socioeconomic factors contributing to its concentration among specific households and their implications for maternal and child health.
Using the National Family Health Survey-5 (NFHS-5) data ( = 1,75,569 deliveries), we developed a regression model to understand the existing non-institutional deliveries and their predictors. We employed the Erreygers’ Concentration Index (ECI) to quantify the degree of concentration (inequality) of non-institutional deliveries among households. Furthermore, a decomposition analysis was run to analyse the factors contributing to the concentration of non-institutional deliveries in a particular groups of households. It breaks down the overall inequality at population level into its constituent parts to identify the sources of inequality. This approach helps discover prime causes of inequality, such as differences in income, education, or other relevant factors.
Out of the total sampled deliveries in the reference period, around 14% were non-institutional. Inequality analysis (ECI=-0.2174; p-value < 0.0001) suggests that non-institutional deliveries were unequally and unfairly concentrated in low-income households. The concentration of non-institutional deliveries in poor households was majorly contributed by factors like education (13.85%), wealth (13.91%), mass media exposure (12.27%) region (9.76%), birth order (3.17%), distance to health facilities (2.77%), caste (2.82%), timing of first ANC visit (1.07%), and women considering having to take transport as a problem (1.60%).
This research employs inequality analyses of non-institutional deliveries and contributes to the existing literature by establishing its unfair concentration among poor households in India. It expands our understanding of the factors driving non-institutional deliveries among the disadvantaged. The findings highlight the importance of targeted interventions and policies to reduce the concentration of last-mile non-institutional deliveries among vulnerable women living in marginalized households.
The online version contains supplementary material available at 10.1186/s12905-025-03819-8.
非机构分娩，即医疗机构以外的分娩，仍然是一个重大的全球问题。它带来严重的母婴健康问题，并显著导致母婴死亡。在过去20年里，印度的非机构分娩持续减少。然而，最近下降速度有所放缓，该国仍有相当数量的妇女在医疗机构外分娩。为了更好地了解非机构分娩的持续比例，本研究初步分析了其预测因素。该研究的主要目的是揭示非机构分娩患病率的不平等现象，并了解这些分娩是否不公平地集中在印度的某些家庭中。它还旨在提供与政策相关的见解，以了解导致其集中在特定家庭中的社会经济因素及其对母婴健康的影响。
利用全国家庭健康调查-5（NFHS-5）数据（n = 175569例分娩），我们建立了一个回归模型，以了解现有的非机构分娩情况及其预测因素。我们采用埃雷格斯集中度指数（ECI）来量化非机构分娩在家庭中的集中程度（不平等程度）。此外，进行了分解分析，以分析导致非机构分娩集中在特定家庭群体中的因素。它将总体人口层面的不平等分解为其组成部分，以确定不平等的来源。这种方法有助于发现不平等的主要原因，如收入、教育或其他相关因素的差异。
在参考期内的总抽样分娩中，约14%为非机构分娩。不平等分析（ECI = -0.2174；p值<0.0001）表明，非机构分娩不平等且不公平地集中在低收入家庭。贫困家庭中非机构分娩的集中主要由以下因素造成：教育（13.85%）、财富（13.91%）、大众媒体曝光率（12.27%）、地区（9.76%）、出生顺序（3.17%）、到医疗机构的距离（2.77%）、种姓（2.82%）、首次产前检查时间（1.07%）以及妇女认为交通不便（1.60%）。
本研究对非机构分娩进行了不平等分析，通过确定其在印度贫困家庭中的不公平集中，为现有文献做出了贡献。它扩展了我们对弱势群体中非机构分娩驱动因素的理解。研究结果凸显了有针对性的干预措施和政策对于减少生活在边缘化家庭中的弱势妇女最后一公里非机构分娩集中情况的重要性。
在线版本包含可在10.1186/s12905-025-03819-8获取的补充材料。
