Effect of Health-Facility Admission and Skilled Birth Attendant Coverage on Maternal Survival in India
2014
Research in areas of low skilled attendant coverage found that maternal mortality is paradoxically higher in women who seek obstetric care. Using unmatched population-based case-control analysis of national datasets, the authors compared the effect of health-facility admission at any time (antenatal, intrapartum, postpartum) on maternal deaths (cases) to women reporting pregnancies (controls). Probability of maternal death decreased with increasing skilled attendant coverage, among both women who were and were not admitted to a health-facility; however, the risk of death among women who were admitted was higher (at 50% coverage, OR = 2.32, 95% confidence interval 1.85–2.92) than among those women who were not admitted, while at higher levels of coverage, the effect of health-facility admission was attenuated.
In a secondary analysis, the probability of maternal death decreased with increasing coverage among both women admitted for delivery or who delivered at home, but there was no effect of admission for delivery on mortality risk (50% coverage, OR = 1.0, 0.80–1.25), suggesting that poor quality of obstetric care may have attenuated the benefits of facility-based care.
The effect of health-facility admission did vary by skilled attendant coverage, and this effect appears to be driven partially by reverse causality; however, inequitable access to and possibly poor quality of healthcare for primary and emergency services appears to play a role in maternal survival as well.
Source:
Montgomery AL, Fadel S, Kumar R et al. The Effect of Health-Facility Admission and Skilled Birth Attendant Coverage on Maternal Survival in India: A Case-Control Analysis. PLOS One 2014; 9 (6): e95696. https://doi.org/10.1371/journal.pone.0095696