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Priyanka Dixit and Laxmi Kant Dwivedi

disadvantaged women in rural areas, from poor families, and who are illiterate, Muslim, and sche-
duled caste. Our findings also show that a large proportion of women delivered in an institution and
subsequently deliver at home. These women may not have adequately benefited from their health
care facilities during the delivery of their first child. Therefore, policies may seek to improve the
cleanliness of facilities and the provision of mothers’ friendly services to improve the consistency in
utilization of delivery services.

5. Conclusion

By analyzing NFHS-III data of ever-married women in 2005–2006, this study has provided a new
perspective on the consistent utilization of institutional delivery across successive births. This study
has shown some significant socioeconomic predictors of place of delivery for all three births born
within the five years prior to the NFHS-III, such as region and place of residence, educational level,
wealth index, loss of a child, termination of a pregnancy, and birth order of the child. Multivariate
multilevel models with multiple responses were used to identify whether the women’s behaviors
were independent across different births in relation to institutional delivery. Results show that the
utilization of institutional delivery for subsequent births is significantly related to each other. The
estimated covariates derived from the multivariate multilevel models are positive and highly signifi-
cant, and the finding is that the correlation between successive pregnancies is higher relative to
that between non-successive pregnancies.

Author Contributions

Both PD and LKD conceived of the study design and performed data analyses; PD drafted the ma-
nuscript and offered critical discussion.

Conflict of Interest and Funding

No conflict of interest has been declared by the authors.
Ethics Statement

The study is based on a publically available secondary data set with no identifiable information on
the participants. This dataset is available in the public domain for research use and hence no formal
approval from the institutional review board is required. Therefore, no ethics statement is required
for this study.

Acknowledgements
We thank three anonymous reviewers and the editor for their constructive comments.

References

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