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Tracing pathways from antenatal to delivery care for women in Mumbai, India: cross-sectional study of maternity in low-income areas.

More NS, Alcock G, Bapat U, Das S, Joshi W, Osrin D - Int Health (2009)

Bottom Line: Home births were common if women did not register in advance.In the short term, we suggest an emphasis on birth preparedness for pregnant women and their families, and an effort to rationalize the process of referral between institutions.In the longer term, service improvement needs to acknowledge the private-public mix and work towards practicable regulation of quality in both sectors.

View Article: PubMed Central - PubMed

Affiliation: Society for Nutrition, Education and Health Action (SNEHA), Urban Health Centre, Chota Sion Hospital, 60 Feet Road, Shahunagar, Dharavi, Mumbai 400017, Maharashtra, India.

ABSTRACT
In many cities, healthcare is available through a complex mix of private and public providers. The line between the formal and informal sectors may be blurred and movement between them uncharted. We quantified the use of private and public providers of maternity care in low-income areas of Mumbai, India. We identified births among a population of about 300 000 in 48 vulnerable slum areas and interviewed women at 6 weeks after delivery. For 10,754 births in 2005-7, levels of antenatal care (93%) and institutional delivery (90%) were high. Antenatal care was split 50:50 between public and private providers, and institutional deliveries 60:40 in favour of the public sector. Women generally stayed within the sector and institution in which care began. Home births were common if women did not register in advance. The findings were at least superficially reassuring, and there was less movement than expected between sectors and health institutions. In the short term, we suggest an emphasis on birth preparedness for pregnant women and their families, and an effort to rationalize the process of referral between institutions. In the longer term, service improvement needs to acknowledge the private-public mix and work towards practicable regulation of quality in both sectors.

No MeSH data available.


Progress of clients between types of public sector institution from registration to delivery in Mumbai, India. The breadth of each path is proportional to the number of clients. Urban health centre clients are omitted due to small numbers. Flows in which fewer than 25 women were involved are not included: unregistered to institutional delivery, tertiary to general hospital, tertiary hospital to maternity home, general hospital to maternity home.
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fig2: Progress of clients between types of public sector institution from registration to delivery in Mumbai, India. The breadth of each path is proportional to the number of clients. Urban health centre clients are omitted due to small numbers. Flows in which fewer than 25 women were involved are not included: unregistered to institutional delivery, tertiary to general hospital, tertiary hospital to maternity home, general hospital to maternity home.

Mentions: Moving from a sectoral to an institutional level, the least movement was seen between private hospitals, in which 3011 (28%) deliveries took place. Of the 3043 women who registered at a private hospital, 2503 (82%) delivered at the same hospital. In the public sector too, most women delivered at the institution at which they had registered to do so. Concordance between registration and delivery was high in municipal tertiary hospitals (786/988; 80%) and general hospitals (1752/2260; 78%), but lower at municipal maternity homes (1061/1754; 60%) and urban health centres (189/325; 58%). Figure 2 summarises the progress of clients from registration to delivery in major public sector institutions and includes women who, although they lived in the study areas, had antenatal care, registration or delivery outside Mumbai. Most women who did not register at institutions went on to give birth at home (752/954; 79%). Discordance between registration and delivery was most marked for maternity homes and tertiary hospitals. The major traffic was from maternity home or tertiary hospital registration to home delivery (15% and 11%, respectively) and from maternity home or urban health centre registration to delivery at a tertiary hospital (10% and 22%, respectively).


Tracing pathways from antenatal to delivery care for women in Mumbai, India: cross-sectional study of maternity in low-income areas.

More NS, Alcock G, Bapat U, Das S, Joshi W, Osrin D - Int Health (2009)

Progress of clients between types of public sector institution from registration to delivery in Mumbai, India. The breadth of each path is proportional to the number of clients. Urban health centre clients are omitted due to small numbers. Flows in which fewer than 25 women were involved are not included: unregistered to institutional delivery, tertiary to general hospital, tertiary hospital to maternity home, general hospital to maternity home.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2806942&req=5

fig2: Progress of clients between types of public sector institution from registration to delivery in Mumbai, India. The breadth of each path is proportional to the number of clients. Urban health centre clients are omitted due to small numbers. Flows in which fewer than 25 women were involved are not included: unregistered to institutional delivery, tertiary to general hospital, tertiary hospital to maternity home, general hospital to maternity home.
Mentions: Moving from a sectoral to an institutional level, the least movement was seen between private hospitals, in which 3011 (28%) deliveries took place. Of the 3043 women who registered at a private hospital, 2503 (82%) delivered at the same hospital. In the public sector too, most women delivered at the institution at which they had registered to do so. Concordance between registration and delivery was high in municipal tertiary hospitals (786/988; 80%) and general hospitals (1752/2260; 78%), but lower at municipal maternity homes (1061/1754; 60%) and urban health centres (189/325; 58%). Figure 2 summarises the progress of clients from registration to delivery in major public sector institutions and includes women who, although they lived in the study areas, had antenatal care, registration or delivery outside Mumbai. Most women who did not register at institutions went on to give birth at home (752/954; 79%). Discordance between registration and delivery was most marked for maternity homes and tertiary hospitals. The major traffic was from maternity home or tertiary hospital registration to home delivery (15% and 11%, respectively) and from maternity home or urban health centre registration to delivery at a tertiary hospital (10% and 22%, respectively).

Bottom Line: Home births were common if women did not register in advance.In the short term, we suggest an emphasis on birth preparedness for pregnant women and their families, and an effort to rationalize the process of referral between institutions.In the longer term, service improvement needs to acknowledge the private-public mix and work towards practicable regulation of quality in both sectors.

View Article: PubMed Central - PubMed

Affiliation: Society for Nutrition, Education and Health Action (SNEHA), Urban Health Centre, Chota Sion Hospital, 60 Feet Road, Shahunagar, Dharavi, Mumbai 400017, Maharashtra, India.

ABSTRACT
In many cities, healthcare is available through a complex mix of private and public providers. The line between the formal and informal sectors may be blurred and movement between them uncharted. We quantified the use of private and public providers of maternity care in low-income areas of Mumbai, India. We identified births among a population of about 300 000 in 48 vulnerable slum areas and interviewed women at 6 weeks after delivery. For 10,754 births in 2005-7, levels of antenatal care (93%) and institutional delivery (90%) were high. Antenatal care was split 50:50 between public and private providers, and institutional deliveries 60:40 in favour of the public sector. Women generally stayed within the sector and institution in which care began. Home births were common if women did not register in advance. The findings were at least superficially reassuring, and there was less movement than expected between sectors and health institutions. In the short term, we suggest an emphasis on birth preparedness for pregnant women and their families, and an effort to rationalize the process of referral between institutions. In the longer term, service improvement needs to acknowledge the private-public mix and work towards practicable regulation of quality in both sectors.

No MeSH data available.