title: Are marginalized women being left behind? A population-based study of institutional deliveries in Karnataka, India.
abstract: BACKGROUND
  While India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations.
  
  
  METHODS
  A population-based survey was carried out among 16 randomly selected rural villages in rural Mysore District in Karnataka, India between August and September 2008. All households in selected villages were enumerated and women with children 6 years of age or younger underwent an interviewer-administered questionnaire on antenatal care and institutional delivery.
  
  
  RESULTS
  Institutional deliveries in rural areas of Mysore District increased from 51% to 70% between 2002 and 2008. While increasing numbers of women were accessing antenatal care and delivering in hospitals, large disparities were found in uptake of these services among different castes. Mothers belonging to general castes were almost twice as likely to have an institutional birth as compared to scheduled castes and tribes. Mothers belonging to other backward caste or general castes had 1.8 times higher odds (95% CI: 1.21, 2.89) of having an institutional delivery as compared to scheduled castes and tribes. In multivariable analysis, which adjusted for inter- and intra-village variance, Below Poverty Line status, caste, and receiving antenatal care were all associated with institutional delivery.
  
  
  CONCLUSIONS
  The results of the study suggest that while the Indian Government has made significant progress in increasing antenatal care and institutional deliveries among rural populations, further success in lowering maternal mortality will likely hinge on the success of NRHM programs focused on serving marginalized groups. Health interventions which target SC/ST may also have to address both perceived and actual stigma and discrimination, in addition to providing needed services. Strategies for overcoming these barriers may include sensitization of healthcare workers, targeted health education and outreach, and culturally appropriate community-level interventions. Addressing the needs of these communities will be critical to achieving Millennium Development Goal Five by 2015.
authors.affiliation: School of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Adamson
authors.forename: Karl
authors.initials: K
authors.lastname: Krupp
authors.forename: Bhavana
authors.initials: B
authors.lastname: Niranjankumar
authors.forename: Alexandra H
authors.initials: AH
authors.lastname: Freeman
authors.forename: Mudassir
authors.initials: M
authors.lastname: Khan
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012424:Rural Population; D012923:Social Class; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations