Affordable Access

Publisher Website

Trends in institutional deliveries among disadvantaged groups and the impact of intervention in Gujarat: evidence from secondary data analysis

Authors
Journal
The Lancet
0140-6736
Publisher
Elsevier
Publication Date
Volume
381
Identifiers
DOI: 10.1016/s0140-6736(13)61383-5
Keywords
  • Supplement
  • Meeting Abstracts
Disciplines
  • Education
  • Mathematics

Abstract

Abstract Background An estimated 1·2 million births per year in Gujarat include a significant number of home deliveries. The District Level Household Survey-3 (DLHS-3; 2007) reported nearly 40% of all deliveries in Gujarat occurred at home. Gujarat's maternal mortality rate was reduced from 202 to 148 per 100 000 deliveries between 2000 and 2010. Despite the overall progress, issues such as access and equity are contributing to wide disparities between different populations in the state. The financial barrier is the limiting factor for access to institutional deliveries among poor women. The Chiranjeevi scheme was introduced to increase access to institutional deliveries, particularly to poor women. The scheme provides free delivery care in private health-care facilities for women from below-poverty-line (BPL) families. Methods Secondary data analysis was done for the DLHS-3 and the coverage evaluation survey, a UNICEF dataset. The determinants were place of residence, education, caste, and wealth index. The outcome variables included institutional delivery, defined as delivery in a hospital, clinic, or health centre. In the DLHS, wealth index was computed by combining household amenities, assets, and durables, and then divided into quintiles. In this analysis, the poorest and second wealth quintiles were grouped into the poor category while the non-poor included the top three quintiles. Education status was divided into non-literate, fewer than 5 years of education, and 5 or more years of education. The analysis included trends in the institutional deliveries among rural, poor, non-literate, scheduled castes, and scheduled tribe women who delivered during the reference period (Jan 1, 2004, until survey year 2008). Further, we used a before–after intervention approach to evaluate the impact of the Chiranjeevi Yojana on rates of institutional deliveries among the disadvantaged groups. Findings The results show an increase in institutional deliveries from 2005 to 2009 among the disadvantaged groups, including the rural population, scheduled caste and tribes, poor, non-literate, and BPL families. Overall, there was a 32% increase in institutional deliveries between 2005 (658 780 of 1 155 148 [57%] deliveries) and 2009 (943 037 of 1 054 852 [89%] deliveries). The increase in institutional deliveries was from 52·2% to 56·5% between DLHS-2 (2002–04) and DLHS-3 (2007–08), respectively. The impact of the intervention is clear when data from 2006, before the Chiranjeevi Yojana programme was implemented, are compared with results since the programme took effect. Interpretation A targeted intervention, the Chiranjeevi scheme in Gujarat, has improved rates of institutional deliveries among disadvantaged groups. Improvement in maternal health outcomes among disadvantaged groups will increase the likelihood of achieving Millennium Development Goal 5 in Gujarat. Funding This work was part of the Evidence for Policy and Implementation 4 project, a capacity-building project funded by a partner driven cooperation fund provided by the Swedish Government to Karolinska Institutet.

There are no comments yet on this publication. Be the first to share your thoughts.