Context: Published in the peer-reviewed journal Global Health Action, the study analyses  the factors that act as a barrier in low coverage of institutional deliveries.
Key Findings

• It is a first-of-its-kind study on utilisation of institutional delivery in the country.
• 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.
• The study analyses data on State-level maternal mortality ratio (2016 to 2018), as well as the National Family Health Survey-4 (2015-2016). 
• 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.  

It pointed out that

• Poverty is responsible for more than twice as much as age at marriage in determining whether a woman will seek institutional delivery.
• Among other factors, interaction with a community health worker and awareness campaigns had a greater impact than age at marriage.
• Education is 1.5 times more important than age at marriage.

Key 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.

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 1st 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.

Road Ahead

• State-specific interventions should not only aim to increase the number of public health facilities but also to improve associated quality of care by underlining that inadequate clinical training and insufficient skilled human resources affected the quality of available maternity services resulting in low coverage of institutional deliveries.