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Role of the private sector in childbirth care: cross‐sectional survey evidence from 57 low‐ and middle‐income countries using D emographic and H ealth S urveys
Author(s) -
Benova Lenka,
Macleod David,
Footman Katharine,
Cavallaro Francesca,
Lynch Caroline A.,
Campbell Oona M. R.
Publication year - 2015
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12598
Subject(s) - childbirth , private sector , public sector , equity (law) , caesarean section , health care , business , developing country , millennium development goals , medicine , economic growth , demographic economics , economics , pregnancy , political science , genetics , economy , law , biology
Objective Maternal mortality rates have decreased globally but remain off track for M illennium D evelopment G oals. 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 D emographic and H ealth S urvey (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 C aesarean 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, C aesarean section rate was higher in the private compared to public sector. The private sector provided between 13% ( L atin A merica) and 66% ( A sia) of C aesarean 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.