Page 129 - IJPS-2-2

International Journal of Population Studies

RESEARCH ARTICLE

Utilization of institutional delivery services

across successive births in India

2
1*
Priyanka Dixit and Laxmi Kant Dwivedi
1 School of Health Systems Studies (SHSS), Tata Institute of Social Sciences (TISS), V. N. Purav Marg,
Deonar, Mumbai 400088, India
2 Department of Mathematical Demography & Statistics, International Institute for Population Sciences
(IIPS), Govandi Station Road, Deonar, Mumbai 400088, India

Abstract: As institutional delivery centers usually have much better modern facilities and hygienic condi-
tions in India, utilization of institutional delivery services could improve maternal and child health. The
objective of this paper is to address the issue of whether women were consistent in delivering births in an
institutional care center over successive pregnancies in India and investigate the factors associated
with consistent utilization of institutional delivery. We applied multivariate multilevel models that allow
for a strong dependence between successive outcomes at the same unit to the third round of the National
Family Health Survey in 2005-2006. Results show that region and place of residence, woman’s education,
wealth index, having experienced the loss of a child, ever having terminated a pregnancy, and birth order
are significant predictors of place of delivery for all three recent births among ever-married women. Our
results further show that previous utilization of institutional delivery was an important predictor of utili-
zation for subsequent institutional deliveries. Policies aimed at improving the wide or persistent utiliza-
tion of institutional delivery in India should focus on first-time mothers targeting disadvantaged women
who are from rural areas, poor families, illiterate, Muslim, and scheduled castes.
Keywords: successive births, consistent utilization, National Family Health Survey, India, multivariate
multilevel models

*Correspondence to: Priyanka Dixit, School of Health Systems Studies (SHSS), Tata Institute of Social Sciences (TISS), V.
N. Purav Marg, Deonar, Mumbai 400088, India; Email: priyanka.dixit@tiss.edu

Received: August 1, 2016; Accepted: September 25, 2016; Published Online: October 3, 2016
Citation: Dixit P and Dwivedi L K. (2016). Utilization of institutional delivery services across successive births in
India. International Journal of Population Studies, vol.2(2): 123–138. http://dx.doi.org/10.18063/IJPS.2016.02.006.
1. Introduction

Copyright: © 2016 Priyanka The government of India has been developing strategies and increased funding to improve maternal
Dixit and Laxmi Kant Dwivedi. health and to achieve universal access to reproductive health in the past couple of decades. Despite
This is an Open Access art-
icle distributed under the terms these efforts (e.g., per capita health spending rose from US$21 in 2000 to US$58 in 2012), India did
of the Creative Commons Att- not meet the Millennium Development Goal (MDG) for the reduction of the maternal mortality ratio
ribution-NonCommercial 4.0 (MMR) by 2015 (WHO et al., 2015: Annex 19), which targeted 140 maternal deaths per 100, 000
International License (http:
//creativecommons.org/lice- live births in 2015 from 556 in 1990, a three-fourth reduction in MMR required by Goal 5 of the
nses/by-nc/4.0/), permitting all MDGs (United Nations, 2015a). This rate of decline is considerably slower than what would be ex-
non-commercial use, distribu- pected to reach India’s Sustainable Development Goal (SGD) target in reducing MMR, which aims
tion, and reproduction in any
medium, provided the original to reach 70 per 100, 000 live births by 2030 (United Nations, 2015b).
work is properly cited. One effective way to improve maternal and newborn health is for mothers to deliver in a health

International Journal of Population Studies | 2016, Volume 2, Issue 2 123