Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys

Lenka Benova, David Macleod, Katharine Footman, Francesca Cavallaro, Caroline A Lynch, Oona M R Campbell

Research output: Contribution to journalA1: Web of Science-article

Abstract

OBJECTIVE: Maternal mortality rates have decreased globally but remain off track for Millennium Development Goals. Good-quality delivery care is one recognised strategy to address this gap. This study examines the role of the private (non-public) sector in providing delivery care and compares the equity and quality of the sectors.

METHODS: The most recent Demographic and Health Survey (2000-2013) for 57 countries was used to analyse delivery care for most recent birth among >330 000 women. Wealth quintiles were used for equity analysis; skilled birth attendant (SBA) and Caesarean section rates served as proxies for quality of care in cross-sectoral comparisons.

RESULTS: The proportion of women who used appropriate delivery care (non-facility with a SBA or facility-based births) varied across regions (49-84%), but wealth-related inequalities were seen in both sectors in all regions. One-fifth of all deliveries occurred in the private sector. Overall, 36% of deliveries with appropriate care occurred in the private sector, ranging from 9% to 46% across regions. The presence of a SBA was comparable between sectors (≥93%) in all regions. In every region, Caesarean section rate was higher in the private compared to public sector. The private sector provided between 13% (Latin America) and 66% (Asia) of Caesarean section deliveries.

CONCLUSION: This study is the most comprehensive assessment to date of coverage, equity and quality indicators of delivery care by sector. The private sector provided a substantial proportion of delivery care in low- and middle-income countries. Further research is necessary to better understand this heterogeneous group of providers and their potential to equitably increase the coverage of good-quality intrapartum care.

Original languageEnglish
JournalTropical Medicine and International Health
Volume20
Issue number12
Pages (from-to)1657-73
Number of pages17
ISSN1360-2276
DOIs
Publication statusPublished - 2015
Externally publishedYes

Keywords

  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Asia
  • Cesarean Section
  • Cross-Sectional Studies
  • Delivery, Obstetric/methods
  • Developing Countries
  • Europe
  • Female
  • Health Services Accessibility
  • Humans
  • Income
  • Latin America
  • Maternal Health Services/standards
  • Maternal Mortality
  • Middle Aged
  • Middle East
  • Midwifery
  • Pregnancy
  • Private Sector
  • Public Sector
  • Social Class
  • Young Adult

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