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Between 1990 and 2010, the global maternal mortality ratio (MMR) i.e. the number of maternal deaths per 100 000 live births declined by only 3.1% per year. This is far from the annual decline of 5.5% which was required to achieve MDG5. In India, though the annual decline rate has been achieved but the MMR is still high at 167, and has not reached the target level of 100 per 100 000 live birth.1,2 India still accounts for the largest contribution to maternal deaths worldwide. Early and regular attendance of antenatal care and birth under supervision of skilled attendant is associated with reduction in both maternal and perinatal morbidity and mortality. About 80% of global maternal deaths can be prevented or avoided by increasing institutional births or providing skilled care at birth. The National Population Policy has advocated, institutional births as a key strategy to reduce maternal mortality.3-5 Tradition and financial constraints are important factors for women preferring home births, though it is associated with adverse outcomes in mother and infant as compared to facility based births.6,7 The Government of India launched Janani Suraksha Yojana (JSY), a cash incentive scheme for mothers to increase the institutional births in the year 2005 under the National Rural Health Mission (NRHM), with the aim to reduce maternal mortality.8 Delhi is one of the most densely populated cities in the world, and attracts nearly 500 000 migrants every year with most settling in urban poor habitations. According to the National Family Health Survey 3 (NFHS 3) conducted in 2005–2006, only 44.0% of births were institutional among the urban poor of Delhi.9 The District Level Household and Facility Survey (2007– 2008) showed that overall 71.0% of pregnant women had at least three antenatal care (ANC) visits. While 68.0% of births were institutional in the city as a whole, only 38.0% births were institutional in the slum areas.10 This study was conducted with the aim to find the place of birth in an urban resettlement colony of Delhi and to assess the factors which affect the utilization of maternal health services. ABSTRACT Introduction: Institutional births are advocated as a key strategy to reduce maternal mortality This study is aimed to identify whether the practice of place of birth is changing over time and to explore the factors contributing to women’s decision for choice of place of birth. Methods: A community based cross-sectional study was carried out in an urban resettlement colony of Delhi. A semi-structured questionnaire was used to interview the mothers with children less than or equal to 3 years of age. The place of birth was assessed in relation to socio-demographic and obstetric characteristics of the study participants. Reasons for preferring home birth were also analyzed. Results: A total of 1293 mothers were included in the study. Of these majority 1068 (82.6%) had institutional births while 225 (17.4%) were home births. A skilled birth attendant was present in only 39 (17.3%) of home births while 17 (7.5%) mothers gave birth with the help of relatives. Higher socio-economic status and higher income of the family; higher educational status of mother and head of the family was associated with institutional birth and the difference was statistically significant. Main reasons cited for preferring home birth were tradition (29.2%), financial constraints (7.3%), no one to look after (16.3%), pressure from family despite of awareness 6.3%, and other reasons. Conclusions: Institutional births have shown an increasing trend in India, however a significant proportion of women still prefer home as place of birth. Socio-cultural factors and financial constraints have an important role in MCH service utilization and need to be addressed.

Determinants of Place of Birth in an Urban Resettlement Colony of Delhi