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

Diane Coffey, Population Research Center
Nikhil Srivastav, University of Texas at Austin
Aditi Priya, LEAD at Krea University
Asmita Verma, IIT-Delhi
Alok Kumar, Medical Education Department, Government of Uttar Pradesh
Dean Spears, University of Texas at Austin

India is home to almost one-fourth of neonatal deaths. Two-thirds of India’s neonatal deaths occur in Empowered Action Group (EAG) states. The neonatal mortality rate (NMR) among rural births in EAG states was 39 per 1000 in 2015. Efforts have focused on promoting institutional rather than at-home deliveries, without investigating differences between births in public and private facilities. We analyze India's 2015-16 DHS (NFHS), computing NMR by place of birth for the rural populations of EAG and non-EAG states. We standardize demographic rates by socioeconomic status. We find that, 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. In India’s EAG states, rural births in private facilities experience exceptionally high NMR. Evidence indicates that the average quality of care in private facilities serving this population is low.

Keywords: Mortality, Children and youth, Decomposition analysis/methods

See paper.

  Presented in Session 21. What Affects Child Health: Perspectives from India