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

Abstract

Abstractobjective 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 goodquality intrapartum care.

Early breastfeeding practices: Descriptive analysis of recent Demographic and Health Surveys

“…Where a choice of childbirth setting is available, the individual characteristics of service users may explain differences in breastfeeding practice by delivery setting. Compared to poorer women, a higher proportion of richer women receive appropriate delivery care (Benova et al, ). Although there is little consistent evidence that early breastfeeding practices differ by indicators of wealth (Barros, Victora, Scherpbier, & Gwatkin, ), adjusting for socioeconomic characteristics would be desirable.…”

“…Differences in early breastfeeding practices by sector of facility were largest in Latin America; between 15% and 20% higher in for births in the public sector for all breastfeeding outcomes. In a recent assessment of childbirth location using DHS data, 24% of all deliveries in Latin America were by caesarean section, rising to 45% for births in the private sector (Benova et al, ). The high prevalence of caesarean delivery, known to be associated with lower breastfeeding initiation (Dewey, Nommsen‐Rivers, Heinig, & Cohen, ; Miller et al, ; Takahashi et al, ; Zanardo et al, ), may help to explain the public–private differential in this region.…”

“…Public‐sector childbirth locations were those occurring in public, government or social security health facilities. Private‐sector locations were those occurring in facilities outside the public sector, such as in private facilities, private health professional locations, faith‐based organisation facilities, non‐governmental organisation facilities, and other private facilities, as previously described (Benova et al, ). Respondents were asked to list all people who assisted with the delivery; we considered the person with the highest level of qualification, and classified home‐based births as having been attended by a skilled birth attendant (SBA) or not, according to country‐level criteria (Benova et al, ; Footman et al, ).…”

Who, What, Where: an analysis of private sector family planning provision in 57 low‐ and middle‐income countries

“…We also described whether women were informed of side effects as a proxy for content and quality of care. This paper links to a Series on private sector provision of family planning and maternal/ newborn services, including two in-depth papers on antenatal [42] and delivery care [43], and an exploration of methodological issues [44].…”

Maternal mortality and health in the Arab World: A 25‐year epidemiological study

“…This can be attributed to several factors which were common among almost all Arab countries, but were variable depending on the financial situation and overall resources found in each country. First, there has been an increased dependence on skilled birth attendant (SBA) in deliveries in the most countries worldwide, including the Arab world . The WHO defines an SBA as a health professional (doctor or nurse) who has been trained and educated to adequately manage normal (uncomplicated) pregnancies, childbirth, immediate post‐natal care and identify and deal with any possible complication that may fall on a mother of newborn during the childbirth process .…”