What is institutional delivery?
Giving birth to a child in a healthcare institution under the overall supervision of trained and competent health personnel where there are more amenities to handle the situation to care and save the life of the child and mother is Institutional delivery.
Giving birth at home is Non - institutional delivery. The chances of getting infected from the unhygienic environment are more in the case of delivery of a child at home. Sometimes, it is very tough or impossible to handle childbirth complications.
The ancient method of delivering the child at home is still prevalent practice in India. It is seen to be more common in rural areas as compared to urban areas.
Institutional births result in reduced infant and maternal mortality and increased overall health status of the mother and the child.
Institutional and Non-institutional Deliveries
According to 2001 census in India, a look at the break-up of the place of last delivery reveals that 59% of the children were delivered at an institution and the remaining 41% were given birth at home
Main Reasons for Delivering at the Institution
|
Reasons for Delivering |
Response Rate % (No.) |
|
Delivery is easy and convenient |
73.7 (87) |
|
Faith in doctor |
21.2 (25) |
|
Proximity to the hospital |
19.5 (23) |
|
Problems related to home deliveries |
13.6 (16) |
|
Advised by health functionaries |
12.7 (15) |
|
Worry about infection at home |
6.8 (8) |
|
All previous deliveries were at institution |
5.9 (7) |
|
Precipitate labor |
4.2 (5) |
At Home
|
Reasons for Delivering |
Response Rate % (No.) |
|
Cultural practice |
68.3 (56) |
|
Inadequate systems including a shortage of supplies and drugs in hospitals |
25.6 (21) |
|
Home delivery is easy and convenient |
24.4 (20) |
|
Poor quality of care |
20.7 (17) |
|
Onset of labor before the expected date/Precipitate labor |
14.6 (12) |
|
Distance of the hospital |
13.4 (11) |
|
Lack of transportation |
9.8 (8) |
|
Lack of escort during labor |
8.5 (7) |
|
All previous deliveries were at home |
6.1 (5) |
|
Fear about hospital |
4.9(4) |
|
Fear of surgical procedures |
4.9 (4) |
|
Family members preference for home delivery |
3.7 (3) |
|
Financial problems at home/worries about cost of care in the hospital |
3.7 (3) |
|
Inappropriate referral system leading to overcrowding in urban hospitals |
3.7 (3) |
|
Negative attitude of staff in health facilities |
2.4 (2) |
Place of Delivery
The following table shows the total percentage of children born in an institution, 89% of the deliveries were conducted in government facilities and only 11% had utilized the services of private healthcare sectors.
The old customs have played a vital role in case of place of the delivery of a child when it is non-institutional delivery. It is unfortunate that a woman bringing a new life on the earth sometimes treated as impure by her own family until she is allowed inside house only after having bath. Hence about 32% of the deliveries were conducted either in a separate room or outside the home surrounded by a wall of a cloth or at the backyard.
|
Institutional deliveries |
Non-institutional deliveries |
||||
|
Government hospital |
Private hospital |
Inside the house |
Outside the house |
In a room |
Backyard of the house |
|
89.0 (105) |
11.0 (13) |
61.0 (50) |
4.9 (4) |
31.7 (26) |
2.4 (2) |
No*: People involved in the survey.
Indian states ranking by institutional delivery
This is a list of the States of India ranked in order of percentage of children delivered in hospital. This information was gathered from Family Welfare Statistics 2011.[1][2]
|
Rank |
States |
Institutional delivery (%) Family Welfare Statistics 2011 |
Rank |
States |
Institutional delivery (%) Family Welfare Statistics 2011 |
|
1 |
Kerala |
99.8 |
19 |
Jammu and Kashmir |
76.1 |
|
1
|
Tamil Nadu |
99.8 |
20 |
Manipur |
75.5 |
|
3 |
Goa |
99.5 |
21 |
Punjab |
68.5 |
|
4 |
Andhra Pradesh |
94.4 |
22 |
West Bengal |
68.5 |
|
5 |
Arunachal Pradesh |
94.2 |
23 |
Nagaland |
66.8 |
|
6 |
Karnataka |
93.7 |
24 |
Himachal Pradesh |
63.5 |
|
7 |
Gujarat |
91.8 |
25 |
Uttarakhand |
60.7 |
|
8 |
Maharashtra |
90.7 |
26 |
Uttar Pradesh |
57.9 |
|
9 |
Rajasthan |
88.5 |
27 |
Chhattisgarh |
54.4 |
|
10 |
Bihar |
85.4 |
U/T |
Meghalaya |
44.8 |
|
11 |
Madhya Pradesh |
83.9 |
U/T |
Puducherry |
99.9 |
|
12 |
Tripura |
83.6 |
U/T |
Andaman and Nicobar Islands |
98.7 |
|
13 |
Odisha |
82.3 |
U/T |
Delhi |
95.3 |
|
14 |
Sikkim |
81.8 |
U/T |
Chandigarh |
89.0 |
|
15 |
Mizoram |
81.4 |
U/T |
Daman and Diu |
87.8 |
|
16 |
Haryana |
80.2 |
U/T |
Lakshadweep |
73.4 |
|
17 |
Assam |
78.1 |
U/T |
Lakshadweep |
54.4 |
|
18 |
Jharkhand |
77.8 |
|
|
Programs by government to encourage institutional delivery
Many programs in India like the Child Survival and Safe Motherhood (CSSM) and the Reproductive and Child Health (RCH) programs are focused on this aspect.
Under these programs, encouraging deliveries in proper hygienic conditions only by trained health staff and to provide better health care to the mothers and children are emphasized. Our government’s commitment in this direction is reflected in the goals of the National Population Policy (NPP), National Health Policy (NHP), and the National Rural Health Mission (NRHM) launched by the Honorable Prime Minister of India on 12 April 2005. The NRHM has a safe motherhood intervention program (Janani Suraksha Yojana-JSY). The objective of JSY is to reduce Maternal Mortality Rate (MMR) and Neo-natal Mortality Rate (NMR) through the promotion of institutional deliveries.
References: Health and Population: Perspectives and Issues Vol. 32 (3), 131-140, 2009
SUGATHAN K.S., VINOD MISHRA & ROBERT D. RETHERFORD (2001): Promoting Institutional Deliveries in Rural India: The Role of Ante-natal Care Services; National Family Health Survey Subject Reports, Number 20, December. 2. National Rural Health Mission (2005-2012), Mission Document, Ministry of Health and Family Welfare, Government of India. 3. International Institute for Population Sciences (1995): National Family Health Survey: Punjab 1992-93, Bombay, IIPS. 4. International Institute of Population Sciences and ORC Macro (2001): National Family Health Survey: Punjab 1998-‘99, Bombay, IIPS. 5. www.nfhsindia.org/factsheets. 6. Census of India 2001; Registrar General of India. 7. RAJESWARI BALAJI, DILIP T.R. & RAVI DUGGAL (2003): Utilization and Expenditure on Delivery Care Services: Some Observations from Nashik District, Maharashtra’, Regional Health Forum, WHO South-East Asia Region, Vol. 7, No. 2, 2003. 8. http://wcd.nic.in/nationalguidelines.pdf
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