Excess neonatal mortality among private facility births in rural India: A demographic analysis of a nationally representative survey

• Authors: Dean Spears, Diane Coffey, Nikhil Srivastav, Aditi Priya, Asmita Verma, Alok Kumar
• Working paper
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Abstract

Background

India is home to almost one-fourth of neonatal deaths. Two-thirds of India’s neonatal deaths occur in Empowered Action Group (EAG) states. Despite policy focus on maternal and newborn health, the neonatal mortality rate (NMR) among rural births in EAG states was 39 per 1000 in 2015. Research and policy efforts have focused on promoting institutional rather than at-home deliveries, without investigating differences between births in public and private facilities.

Methods

We conduct demographic analysis of birth histories from a 2015-16 representative survey of India, computing NMR by place of birth for the rural populations of EAG and non-EAG states. We standardize demographic rates by socioeconomic status.

Findings

In the rural population of EAG states, NMR among private facility births is 52 per 1000 (95% CI: 48-56), compared with 34 per 1000 in public facilities (95% CI: 32-36) and 43 for home births (95% CI: 40 – 46). After standardizing by socioeconomic status, the NMR gap between private and public facility births increases from 18 to 29. Births in private facilities have higher NMR than births in public facilities in this population even stratifying on key predictors of neonatal mortality.

Interpretation

Promoting facility birth may accelerate declines in NMR. Yet, in India’s EAG states, rural births in private facilities experience exceptionally high NMR. Evidence indicates that the quality of care in private facilities serving this population is very low (although some selection of high-risk births into private facilities cannot be ruled out). Further attention to private facilities in EAG states is needed.