Suchergebnisse

AbstractUniversal health coverage is central to the development agenda to achieve maternal and neonatal health goals. Although there is evidence of a growing preference for institutional births in India, it is important to understand the pattern of switching location of childbirth and the factors associated with it. This study used data from the fourth round of the National Family and Health Survey (NFHS-4) conducted in India in 2015–16. The study sample comprised 59,629 women who had had at least two births in the five years preceding the survey. Bivariate and multivariate logistic regression analyses were applied to the data. About 16.4% of the women switched their location of childbirth between successive births; 9.1% switched to a health facility contributing to a net increment of 1.9% in institutional delivery, varying greatly across states and regions. There was at least a 4 percentage point net increment in institutional births in Chhattisgarh, Bihar, Punjab and Haryana, but the shift was more in favour of home births in Madhya Pradesh, Odisha and West Bengal. Women with high parity and a large birth interval had higher odds of switching their place of childbirth, and this was in favour of a health facility, while women with higher education, from lower social groups, living in urban areas, who had not received four antenatal care visits, and who belonged to a higher wealth quintile had higher odds of switching their place of childbirth to a health facility, despite having lower odds of switching their childbirth location. The study provides evidence of women in India switching their location of childbirth for successive births, and this was more prevalent in areas where the rate of institutional delivery was low. Only a few states showed a higher net increment in favour of a health facility. This suggests that there is a need for action in specific states and regions of India to achieve universal health coverage.

Abstract Background Uttar Pradesh (UP) is the most populous state in India with historically high levels of fertility rates than the national average. Though fertility levels in UP declined considerably in recent decades, the current level is well above the government's target of 2.1. Data and methods Fertility and family planning data obtained from the different rounds of Sample Registration System (SRS) and the National Family Health Survey (NFHS). We analyzed fertility and family planning trends in India and UP, including differences in methods mix, using SRS (1971–2016) and NFHS (1992–2016). Bivariate and multivariate regression analyses were used. Results From 2000, while the total fertility rate (TFR) declined in UP, it is still well above the national level in 2015–16 (2.7 vs 2.18, respectively). The demand for family planning satisfied increased from 52 to 72% during 1998–99 to 2015–16 in UP, compared to an increase from 75 to 81% in India. Traditional methods play a much greater role in UP than in India (22 and 9% of the demand satisfied respectively), while use of sterilization was relatively low in UP when compared to the national averages (18.0 and 36.3% of current married women 15–49 years in UP and India, respectively in 2015–16). Within UP, district fertility ranged from 1.6 to 4.4, with higher fertility concentrated in districts with low female schooling, predominantly located in north-central UP. Fertility declines were largest in districts with high fertility in the late nineties (B = 7.33, p < .001). Among currently married women, use of traditional methods increased and accounted for almost one-third of users in 2015–16. Use of sterilization declined but remained the primary method (ranging from 33 to 41% of users in high and low fertility districts respectively) while condom use increased from 17 and 16% in 1998–99 to 23 and 25% in 2015–16 in low and high fertility districts respectively. Conclusions and implications Greater reliance on traditional methods and condoms coupled with relatively low demand for modern contraception suggest inadequate access to modern contraceptives, especially in district with high fertility rates. Family planning activities need to be appropriately scaled according to need and geography to ensure the achievement of state-level improvements in family planning programs and fertility outcomes.