Institutional delivery in rural India: the relative importance of accessibility and economic status
Institutional delivery in rural India: the relative importance of accessibility and economic status
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DOI：
10.1186/1471-2393-10-30
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发表时间：
2010-06-06
影响因子：
3.1
通讯作者：
Ronsmans, Carine
中科院分区：
文献类型：
--
作者：
Kesterton, Amy J.;Cleland, John;Ronsmans, Carine
背景资料：熟练助产护理是监测实现千年发展目标5（在1990年至2015年期间将孕产妇死亡率降低四分之三）进展情况的一个重要指标。除了专业护理外，母亲在适当的环境中分娩也很重要，救生设备和卫生条件也有助于降低可能导致母婴死亡或疾病的并发症风险。在过去的十年里，人们越来越关注对寻求护理行为的影响，本研究调查了印度农村分娩地点的决定因素，特别关注评估社区准入和经济状况的相对重要性。方法：利用1992年和1998年两次全国代表性抽样调查的数据，对交付地点的趋势进行了描述性分析，水平（儿童/母亲和社区）的随机效应的逻辑回归模型，使用第二次调查调查的determinations.Results：在这个调查机构寻求在印度农村地区出生的孩子，经济地位出现作为一个更重要的决定因素比访问。经济地位也是最强的影响力之间的选择私人营利或公共设施机构births.Conclusion：更多的产科服务的可用性不会单独解决的问题，机构分娩率低。对于利用私营营利机构的情况尤其如此，因为在这些机构中，服务的距离并不具有重大的调整影响。根据这些调查结果，把重点放在增加对现有服务的需求上似乎是最合理的行动。特别是，需要解决资金限制问题，结果支持印度目前的需求方融资试验。
Background: Skilled attendance at delivery is an important indicator in monitoring progress towards Millennium Development Goal 5 to reduce the maternal mortality ratio by three quarters between 1990 and 2015. In addition to professional attention, it is important that mothers deliver their babies in an appropriate setting, where life saving equipment and hygienic conditions can also help reduce the risk of complications that may cause death or illness to mother and child. Over the past decade interest has grown in examining influences on care-seeking behavior and this study investigates the determinants of place of delivery in rural India, with a particular focus on assessing the relative importance of community access and economic status.Methods: A descriptive analysis of trends in place of delivery using data from two national representative sample surveys in 1992 and 1998 is followed by a two-level (child/mother and community) random-effects logistical regression model using the second survey to investigate the determinants.Results: In this investigation of institutional care seeking for child birth in rural India, economic status emerges as a more crucial determinant than access. Economic status is also the strongest influence on the choice between a private-for-profit or public facility amongst institutional births.Conclusion: Greater availability of obstetric services will not alone solve the problem of low institutional delivery rates. This is particularly true for the use of private-for-profit institutions, in which the distance to services does not have a significant adjusted effect. In the light of these findings a focus on increasing demand for existing services seems the most rational action. In particular, financial constraints need to be addressed, and results support current trials of demand side financing in India.