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

Benova, L; Macleod, D; Footman, K; Cavallaro, F; Lynch, CA; Campbell, OMR; (2015) Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys. Tropical Medicine & International Health , 20 (12) pp. 1657-1673. 10.1111/tmi.12598. Green open access

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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.

Type: Article
Title: Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/tmi.12598
Publisher version: https://doi.org/10.1111/tmi.12598
Language: English
Additional information: Copyright © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
Keywords: delivery care, private sector, multicountry analysis, Demographic and Health Surveys, skilled birth attendant, Caesarean section
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10085511
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