View source for Healthcare: India

===2006-19===
[https://epaper.timesgroup.com/article-share?article=05_09_2022_026_013_cap_TOI  Rema Nagarajan, Sep 5, 2022: ''The Times of India'']

[[File: Institutional deliveries and neonatal mortality, 2006-19.jpg| Institutional deliveries and neonatal mortality, 2006-2019 <br/> From: [https://epaper.timesgroup.com/article-share?article=05_09_2022_026_013_cap_TOI  Rema Nagarajan, Sep 5, 2022: ''The Times of India'']|frame|500px]]


Road construction programmes that improve access increased the probability of an institutional delivery by 11-13 percentage points in India. However, there was no evidence that increased institutional deliveries improved rates of neonatal mortality or post-birth complications, whether the woman delivered in a public or private facility. These were the surprising findings of a study published in the BritishMedical Journal Global Health in July. It indicated that to reduce NMR or toimprove maternal health outcomes, it was not suffi cient to simply increase the proportion of women delivering inhealth facilities or in the presence of askilled health provider. The study authors suggested thatthis may be because these facilitieswere not adequately staffed, trained,or equipped to deliver high-qualityhealth services. They referred to several recent studies that found thateven among the cadres of health workers defi ned as skilled, many did notprovide suffi cient clinical care, whichcould be an important barrier to improving clinical outcomes. The study correlated data on habitations/villages connected throughthe Pradhan Mantri Gram Sadak Yojana (PMGSY) from 2010 to 2015 withthe data on health outcomes sourcedfrom the 2015-16 District Health Survey. Its sample was restricted to women in rural areas who gave birth between December 2010 and March 2015,a total of 1,09,303 mothers and 1,59,570 neonates (newborns). The road construction programmeled to a larger increase in deliveries inpublic hospitals relative to other typesof facilities, observedthe study. In the studysample, 71. 2% of deliveries took place in public health facilities and only 15. 2% in a private hospital.

“The PMGSY was responsible for theobserved increases in institutional deliveriesin our sample and (this)was in keeping with thefi ndings of other studieswhich have shown thatdistance and travel costs are important barriers to facility delivery, barriers that were minimised by PMGSY,”stated the study. It was also found thatroad upgrade was associated with anincrease in the presence of a skilledbirth attendant, doctors and nurses. A connected village appeared tobenefi t illiterate women the most,increasing the likelihood of institutional delivery among them by approximately 29 percentage points. This wasfollowed by women who attained primary and secondary education, for whomthe increase was around 24and 15 percentage points,respectively. Despite road connectionspushing up the proportionof institutional deliveries,the study did not fi nd “anyimprovement in the neonatalor maternal health outcomes”. 

 Though delivery with a skilled attendant was strongly correlated with institutional delivery, prolonged delivery, and bleeding during delivery were more common among women who delivered in an institutional setting, noted the study. But the incidence of high fever post-delivery was higher among women who chose the home delivery setting. 

 The study confi rmed what other studies in the context of low-middle income countries had demonstrated, that transportation is an important barrier to accessing health services. Distance to a facility and lack of transportation have been shown to be key inhibitors of health facility utilisation by pregnant women in rural India. A study in India from 2014 showed that each additional kilometre from the nearest health facility was associated with a 4. 4% decline in the probability of institutional delivery. Women in rural areas in India have been shown to pay twice as much as those in urban areas to travel to clinics to give birth. 

 The study called for more research to better understand why increased institutional deliveries and increased use of other maternal health services did not seem to translate into improvements in health outcomes contrary to the accepted wisdom.

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