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BMC Public Health. 2012; 12: 30.
Published online Jan 12, 2012. doi:  10.1186/1471-2458-12-30
PMCID: PMC3269389
Are marginalized women being left behind? A population-based study of institutional deliveries in Karnataka, India
Paul C Adamson,#1 Karl Krupp,#2 Bhavana Niranjankumar,2 Alexandra H Freeman,3 Mudassir Khan,4 and Purnima Madhivanancorresponding author2,5
1School of Medicine, University of California, San Francisco, CA, USA
2Public Health Research Institute of India, Mysore, Karnataka, India
3School of Medicine, George Washington University, Washington, DC, USA
4Department of Community Medicine, Mysore Medical College & Research Institute, Mysore, KA, India
5Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
corresponding authorCorresponding author.
#Contributed equally.
Paul C Adamson: Paul.Adamson/at/ucsf.edu; Karl Krupp: karl_krupp/at/phrii.org; Bhavana Niranjankumar: bhavanaskumar/at/gmail.com; Alexandra H Freeman: jana.h.freeman/at/gmail.com; Mudassir Khan: mdkhan/at/gmail.com; Purnima Madhivanan: pmadhiva/at/fiu.edu
Received September 20, 2011; Accepted January 12, 2012.
Abstract
Background
While India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations.
Methods
A population-based survey was carried out among 16 randomly selected rural villages in rural Mysore District in Karnataka, India between August and September 2008. All households in selected villages were enumerated and women with children 6 years of age or younger underwent an interviewer-administered questionnaire on antenatal care and institutional delivery.
Results
Institutional deliveries in rural areas of Mysore District increased from 51% to 70% between 2002 and 2008. While increasing numbers of women were accessing antenatal care and delivering in hospitals, large disparities were found in uptake of these services among different castes. Mothers belonging to general castes were almost twice as likely to have an institutional birth as compared to scheduled castes and tribes. Mothers belonging to other backward caste or general castes had 1.8 times higher odds (95% CI: 1.21, 2.89) of having an institutional delivery as compared to scheduled castes and tribes. In multivariable analysis, which adjusted for inter- and intra-village variance, Below Poverty Line status, caste, and receiving antenatal care were all associated with institutional delivery.
Conclusion
The results of the study suggest that while the Indian Government has made significant progress in increasing antenatal care and institutional deliveries among rural populations, further success in lowering maternal mortality will likely hinge on the success of NRHM programs focused on serving marginalized groups. Health interventions which target SC/ST may also have to address both perceived and actual stigma and discrimination, in addition to providing needed services. Strategies for overcoming these barriers may include sensitization of healthcare workers, targeted health education and outreach, and culturally appropriate community-level interventions. Addressing the needs of these communities will be critical to achieving Millennium Development Goal Five by 2015.
Keywords: Reproductive health, Millennium Development Goals, Maternal mortality, India, Women's health
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