Institutional delivery pertains to childbirth that occurs in a medical institution under the supervision of competent health professionals. This term usually refers to circumstances where amenities are available to safely manage the situation for both mother and child. Initiatives like Janani Suraksha Yojana (JSY), Pradhan Mantri Matru Vandana Yojana (PMMVY), LaQshya Programme, Poshan Abhiyaan, and National Family Health Survey-4 are all related to promoting institutional deliveries.
Study on Factors Determining Institutional Delivery
A recent study published in the Global Health Action journal explored factors causing low coverage of institutional deliveries. The study, first of its kind, found that poverty, education, and exposure to a community health worker were more significant factors than age at marriage in deciding if a mother will have a safe medical facility birth. This finding comes at a crucial time, as the government considers raising the women’s marriageable age to 21 years to reduce maternal mortality.
The study analyzed state-level maternal mortality ratio (2016 to 2018) and National Family Health Survey- (NFHS) 4 data (2015-2016). It concentrated on nine high-maternal mortality burden states – Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh, and Uttarakhand – which have half of India’s population and contribute substantially to the country’s and global maternal deaths statistics.
Institutional Delivery: Key Findings of the Study
The research concluded that poverty is twice as important as age at marriage in determining whether a woman will seek institutional delivery. Comparatively, education is 1.5 times more vital than age at marriage. Interaction with a community health worker and awareness campaigns also had a greater impact than the age at marriage.
Moreover, the influence of educational attainment was most significant in Assam and Chhattisgarh. There, women with higher education were five times more likely to deliver in a health facility than women without education. Barriers such as distance to the health facility, lack of transportation, costs, facility closures, and trust issues were also highlighted in the study.
Institutional Deliveries in India: National Scenario
Over the past two decades, India has made significant strides in increasing institutional deliveries. According to NFHS-4, institutional deliveries rose from 39% in 2005-06 to 79% in 2015-16. Furthermore, institutional births in public institutions increased from 18% to 52% during the same period.
Initiatives to Enhance Institutional Deliveries
The Indian government has rolled out several schemes to encourage institutional delivery among pregnant women. The Janani Suraksha Yojana (JSY), a 100% centrally sponsored scheme, aims to reduce maternal and infant mortality. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) focuses on conducting special AnteNatal Check-ups (ANC) on the 9th of every month. Pradhan Mantri Matru Vandana Yojana (PMMVY) is a maternity benefit programme, implemented across all Indian districts since January 1, 2017. The LaQshya Programme is intended to enhance the quality of care in labor rooms and maternity operation theaters. Poshan Abhiyaan aims to boost nutritional status among young children and pregnant women.
Suggestions for the Future
To improve institutional delivery rates, state-specific interventions should aim not only to increase public health facilities but also to enhance associated care quality. The government should ensure sufficient availability of medical staff, emergency services such as ambulances, vaccinations, maternity care, and more in urban as well as rural areas. This is due to the impact of inadequate clinical training and insufficient skilled human resources on the overall quality of maternity services.
