Meredith L Wilcox1, Karl Krupp2, Bhavana Niranjankumar3, Vijaya Srinivas4, Poornima Jaykrishna5, Anjali Arun6, Purnima Madhivanan7. 1. Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, University Park, AHC5-477, Miami FL 33199, USA. Electronic address: mwilc003@fiu.edu. 2. Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India; Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA. Electronic address: kkrup002@fiu.edu. 3. Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: bhavanaskumar@gmail.com. 4. Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: drvijaya09@gmail.com. 5. Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: poornima.phri@gmail.com. 6. Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: anjaliarun87@gmail.com. 7. Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, University Park, AHC5-477, Miami FL 33199, USA; Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: pmadhiva@fiu.edu.
Abstract
BACKGROUND: India accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India. METHODS: Between January 2009 and 2011, 1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth. FINDINGS: The median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR]=7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p<0.001) and private institutions (AOR=3.00, p<0.001). CONCLUSIONS AND IMPLICATIONS: As a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status.
BACKGROUND: India accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India. METHODS: Between January 2009 and 2011, 1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth. FINDINGS: The median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR]=7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p<0.001) and private institutions (AOR=3.00, p<0.001). CONCLUSIONS AND IMPLICATIONS: As a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status.