Public health facility quality and place of delivery in India: A decomposition analysis across wealth groups

Abstract

Institutional delivery rates in India remain low, with significant interstate disparities. There is limited research on how supply-side factors influence maternal delivery choices. This study examined whether improvements in the quality of delivery services can impact maternal delivery location decisions using the Integrated Child Health and Immunization Survey (2015–2016). The national survey covered 1510 public planning units (PU) and 44,571 households. We constructed three indices of quality: physical infrastructure, health staff availability, and equipment and vaccine availability. Using multinomial probit regression, we analyzed the relationship between place of delivery for the household’s youngest child under age two and PU quality. Additionally, we conducted Fairlie decomposition analysis to examine factors contributing to differences in delivery location by income group. Mothers living near higher-quality public health facilities, as assessed by all three indices, were more likely to deliver in public facilities and less likely to choose private facilities or home births. The effects of the equipment and vaccine availability index were the strongest and most consistent across terciles, followed by the health staff index in urban areas and the infrastructure index in rural areas. Households in the bottom two wealth quintiles had access to lower-quality public health facilities. Limited access to quality facilities was linked to lower institutional delivery rates when compared to households in the top three wealth quintiles. Improving the quality of health facilities, particularly in low-income areas, can improve institutional delivery rates in public facilities.