Delivery at Home Versus Delivery at a Health Care Facility – A Case Study of Bihar, India
Improvement in maternal health care is at the center stage of policy making for many developing countries including India, which is faced with a high maternal mortality rate of 540 deaths per 100,000 live births. In India, 36% of women are underweight and an important policy question is whether maternal health care has any effect on the longterm health of mothers. In this paper, we investigate whether place of delivery (delivery at health care facility versus delivery at home) has any effect on the body mass index of women and children. This relationship is estimated in the context of Bihar, India where only one in five births take place at a health facility. Data on Bihar is taken from the third round of National Family Health Survey conducted in 2005-2006. The data set contains information on women aged between 15 to 49 years and children below the age of 5. We use the program evaluation approach to estimate the treatment effects associated with deliveries at health care institutions for women. Propensity score matching is used to estimate the average treatment effect on the treated (ATT). For underweight women, we find that ATT is positive and highly significant. This implies that there are average gains from delivering at a health facility as compared to delivering at home for underweight women. Using the propensity score results we find that education, urbanization, and higher household wealth increase the likelihood of using health institutions for child deliveries. Therefore, we recommend that (i) awareness should be spread about the positive health impacts of institutional deliveries though educational programs, (ii) there is a need for more investment in health infrastructure in Bihar, and (iii) maternal health care should be made accessible and affordable to poor households.
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