Factors Determining Institutional Delivery in India | 27 Dec 2021

Why in News

Recently, a paper published in the peer-reviewed journal Global Health Action analysed the factors that act as a barrier in low coverage of institutional deliveries.

• According to the study, poverty, education, and exposure to a community health worker are more important than age at marriage in determining whether a mother will be able to have a safe birth in a medical facility.
• The research comes at a time when the government has proposed to raise the age of marriage for women to 21 years in order to reduce maternal deaths.

Key Points

• About:
  • Study: It is a first-of-its-kind study on utilisation of institutional delivery in the country.
    • The study is unique in its exploration of socio-demographic factors as well as barriers in low coverage of institutional deliveries, which is a key intervention in averting the risk of maternal mortality due to childbirth-related complications.
  • Data: The study analyses data on State-level maternal mortality ratio (2016 to 2018), as well as the National Family Health Survey- (NFHS) 4 (2015-2016).
  • Focus of Study: It focuses on nine Low-Performing States (LPS) with high burden of maternal mortality — Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand.
    • These States constitute about half of the country’s population and contribute 62% of maternal deaths, 71% of infant deaths, 72% of under-five (years) deaths, and 61% of births in the country.
    • They also account for 12% of global maternal deaths.
    • India has a maternal mortality rate of 113 per 100,000, and the rate remains “alarmingly high” in these nine States at 161 deaths per 100,000.
• Findings of the Study (Socio-demographic factors):  
  • Poverty is responsible for more than twice as much as age at marriage in determining whether a woman will seek institutional delivery.
    • In Assam, women from the richest wealth index were almost 14 times more likely to deliver in a health institution than those from the poorest wealth index.
    • Similarly, the odds of delivering in a health facility among the richest women were about five to six-fold higher in states like Jharkhand, Madhya Pradesh, and Uttarakhand than the poorest women.
  • Education is 1.5 times more important than age at marriage.
  • Among other factors, interaction with a community health worker and awareness campaigns had a greater impact than age at marriage.
    • The influence of educational attainment appeared to be strongest in Assam and Chhattisgarh, where women with a higher level of education were about five times more likely to deliver in a health facility than women who had no education.
  • However, distance to the health facility and age at marriage had almost similar influences on institutional deliveries.
    • As far as barriers in accessing institutional deliveries were concerned, about 17% of women expressed distance or lack of transportation, and 16% cited costs, to be some of the challenges.
  • Other reasons were facility closures (10%), poor service or trust issues (6%).
• Institutional Deliveries in India:
  • National Scenario: Over the past two decades, India has made progress in increasing the number of institutional deliveries.
    • Institutional births have increased substantially with over four-fifths of the women delivering in institutions in 19 States and UTs (NFHS-5).
      • Institutional delivery is over 90% in 14 out of the total 22 States and UTs.
    • According to the NFHS-4, institutional deliveries increased from 39% in 2005-06 to 79% in 2015-16.
      • Further, the institutional births in public institutions increased from 18% to 52% in the same time period.
  • Step Taken to Increase Institutional Deliveries:
    • Janani Suraksha Yojana: Janani Suraksha Yojana (JSY) is a 100% centrally sponsored scheme which is being implemented with the objective of reducing maternal and infant mortality by promoting institutional delivery among pregnant women.
    • Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): It has been launched to focus on conducting special AnteNatal Check-ups (ANC) checkup on 9th of every month with the help of Medical officers to detect and treat cases of anaemia.
    • Pradhan Mantri Matru Vandana Yojana (PMMVY): It is a maternity benefit programme being implemented in all districts of the country with effect from 1^st January, 2017.
    • LaQshya Programme: LaQshya (Labor room Quality Improvement Initiative) intended to improve the quality of care in the labor room and maternity operation theatres in public health facilities.
    • Poshan Abhiyaan: The goal of Poshan Abhiyaan is to achieve improvement in the nutritional status of Children (0-6 years) and Pregnant Women and Lactating Mothers in a time-bound manner.

Way Forward

• The state-specific interventions should not only aim to increase the number of public health facilities but also to improve associated quality of care.
  • The inadequate clinical training and insufficient skilled human resources affected the quality of available maternity services resulting in low coverage of institutional deliveries.
• The government should ensure adequate availability of medical staff, emergency medical services such as ambulances, vaccinations, maternity care,etc. to the urban as well as rural areas.

Source: TH