Quantifying the health benefits of hospital births

说明(申请人提供)：项目摘要在许多发展中国家，孕产妇和儿童死亡率居高不下。根据最新的估计，2008年全世界发生了358,000例产妇死亡。其中99%的死亡发生在发展中国家。仅印度一国就占所有孕产妇死亡人数的18%左右。新生儿死亡率也居高不下，约占5岁以下儿童死亡总数的40%。其中许多死亡被认为是可以通过在孕期和分娩期间获得更高质量的护理来预防的，因此，全球卫生政策的重点是促进在卫生设施中的分娩，以此作为降低发展中国家孕产妇和新生儿死亡率的战略。这些政策隐含地假设，在卫生机构分娩的妇女有很大的质量收益，这转化为健康结果的改善。在印度，55%的新生儿是在家里出生的。预期的巨额“回报”推动了每年在激励妇女在卫生设施分娩的方案上的巨额支出。然而，令人惊讶的是，几乎没有好的证据表明在卫生机构分娩的“价值”(以降低死亡率或发病率来衡量)。之前的研究试图衡量在医疗机构分娩的女性和在家分娩的女性之间的死亡率差异，但一直存在选择问题。显然，选择在家分娩的女性与选择机构分娩的女性不同。这种未被观察到的异质性是获得可靠的设施交付回报估计的最大障碍。在这项使用公开的二次数据的研究中，我们采用了一种创新的方法来试图估计在卫生机构分娩对死亡率的影响。我们利用交付时印度降雨模式的外源变化，并利用这种变化来 研究在保健机构分娩对新生儿和孕产妇死亡率和发病率的影响。我们的方法基本上比较了两组妇女；一组在医疗机构分娩，另一组在家中分娩，两组之间唯一的区别是，一组在分娩时天气很好，因此能够到达医疗机构，而另一组在分娩时天气不好，因此无法到达医疗机构。估计的大小 这些“回报”是至关重要的，因为这些保单是否通过了成本效益测试，并且 对稀缺的发展资金的良好投资，取决于在卫生设施中提供服务的“回报”的大小。

DESCRIPTION (provided by applicant): Project Summary Maternal and child mortality rates remain high in many developing countries. According to the most recent estimates, 358,000 maternal deaths occurred worldwide in 2008. 99 percent of these deaths took place in a developing country. India alone accounted for about 18 percent of all maternal deaths. Neonatal mortality also remains high, accounting for about 40 percent of all deaths in children under-5. Many of these deaths are believed to be preventable with access to better quality care during pregnancy and childbirth, and global health policies accordingly focus on promoting deliveries in health facilities as a strategy for reducing maternal and neonatal mortality in developing countries. These policies implicitly assume that there are large quality gains for women who deliver in a health facility, that translate to improvements in health outcomes. In India 55 percen of births take place at home. The expected large "returns" drives the huge amounts of expenditure annually on programs to incentivize women to deliver in a health facility. There is however surprisingly little good evidence about the "value" of giving birth in a health facility (measured in terms of reductions in mortality or morbidity). Previous research trying to measure mortality differences between women who deliver in a health facility and women who deliver at home has suffered from selection problems. Clearly, women who choose to give birth at home are different from women who choose a facility delivery. This unobserved heterogeneity represents the single biggest hurdle to obtaining reliable estimates of the returns to facility deliveries. In this study using publicly available secondary data, we adopt an innovative approach to trying to estimate the mortality impacts of giving birth in a health facility. We explot exogenous variation in rainfall patterns in India at the time of delivery and use this variation to study the impact of delivering in a health facility on neonatal and maternal mortality and morbidity. Our approach essentially compares two groups of women; one group that deliver in a health facility and the other group that deliver at home, where the only difference between the two groups is that one group was "lucky" to have had good weather at the time of delivery and so was able to get to the health facility, while the other group was "unlucky" to have bad weather at the time of delivery and so could not get to the health facility. Estimating the size of these "returns" is critical because whether or not these policies pass a cost-benefit test, and are a good investment of scarce development dollars, depends on the size of the "returns" to delivering in a health facility.