Prevalence and Determinants of Institutional Delivery among Teenage Mothers (15-19 years) in India: Evidences from the NFHS-5 Survey.

Abstract

Background: Maternal conditions are among the top five leading causes of disability-adjusted life years and deaths among girls aged 15-19 years, as they are at a greater risk of complications when pregnant. However, most maternal deaths can be averted with timely care, and institutional delivery is an established strategy for reducing maternal mortality and morbidity. This study estimated the prevalence and examined the determinants of institutional delivery among teenage mothers (15-19 years) across Indian states and analyzed the factors influencing institutional delivery.

Materials and methods: We conducted analytical cross-sectional study using data from the fifth round of the National Family Health Survey (NFHS-5) (2019-2021). A sample of 4882 teenage mothers aged 15-19 years who had given birth before the survey were included in the study. Sample weights were applied to ensure representation. Binary logistic regression established significant association between institutional delivery and predictor variables.

Results: An increasing trend in institutional delivery of teenage mothers from 84.7% in the fourth round of the National Family Health Survey (NFHS-4) to 90.6% in NFHS-5 was observed. However, regional differences across states persist in the country. A multitude of socio-demographic, cultural economic, and health system factors were found significant. Teen mothers in the age group of 15-17 years (AOR = 2.18, 95% CI = 1.47-3.24), belonging to male-headed household (AOR = 1.32, 95% CI = 1.03-1.69), had at least primary education (AOR = 1.68, 95% CI = 1.22-2.32), and those who received a minimum one antenatal care (ANC) (AOR = 1.53, 95% CI = 1.13-2.06) had higher odds of institutional delivery. In contrast, mothers who are Muslim (AOR = 0.61, 95% CI = 0.46-0.81), scheduled tribes (AOR = 0.55, 95%CI = 0.38-0.80), scheduled caste (AOR = 0.71, 95% CI = 0.51-0.99), and from northeastern (AOR = 0.41, 95% CI = 0.23-0.74) and central India (AOR = 0.56, 95% CI = 0.32-0.95) had lower odds of institutional delivery.

Conclusions: The findings call for strengthening the continuum of maternal healthcare approach to improve institutional delivery specifically in low-performing states with poor maternal health service utilization among less-educated, rural, deprived, young women, and their parents, as they are less likely to choose ANC, institutional delivery, and post-natal care.