title: Availability and distribution of emergency obstetric care services in Karnataka State, South India: access and equity considerations.
abstract: BACKGROUND
  As part of efforts to reduce maternal deaths in Karnataka state, India, there has been a concerted effort to increase institutional deliveries. However, little is known about the quality of care in these healthcare facilities. We investigated the availability and distribution of emergency obstetric care (EmOC) services in eight northern districts of Karnataka state in south India.
  
  
  RESULTS
  We undertook a cross-sectional study of 444 government and 422 private health facilities, functional 24-hours-a-day 7-days-a-week. EmOC availability and distribution were evaluated for 8 districts and 42 taluks (sub-districts) during the year 2010, based on a combination of self-reporting, record review and direct observation. Overall, the availability of EmOC services at the sub-state level [EmOC = 5.9/500,000; comprehensive EmOC (CEmOC) = 4.5/500,000 and basic EmOC (BEmOC) = 1.4/500,000] was seen to meet the benchmark. These services however were largely located in the private sector (90% of CEmOC and 70% of BemOC facilities). Thirty six percent of private facilities and six percent of government facilities were EmOC centres. Although half of eight districts had a sufficient number of EmOC facilities and all eight districts had a sufficient number of CEmOC facilities, only two-fifths of the 42 taluks had a sufficient number of EmOC facilities. With the private facilities being largely located in select towns only, the 'non-headquarter' taluks and 'backward' taluks suffered from a marked lack of coverage of these services. Spatial mapping further helped identify the clustering of a large number of contiguous taluks without adequate government EmOC facilities in northeastern Karnataka.
  
  
  CONCLUSIONS
  In conclusion, disaggregating information on emergency obstetric care service availability at district and subdistrict levels is critical for health policy and planning in the Indian setting. Reducing maternal deaths will require greater attention by the government in addressing inequities in the distribution of emergency obstetric care services.
authors.affiliation: Division of Epidemiology & Population Health, St John's Research Institute, Bangalore, India. prem_mony@sjri.res.in
authors.forename: Prem K
authors.initials: PK
authors.lastname: Mony
authors.forename: Jayanna
authors.initials: J
authors.lastname: Krishnamurthy
authors.forename: Annamma
authors.initials: A
authors.lastname: Thomas
authors.forename: Kiruba
authors.initials: K
authors.lastname: Sankar
authors.forename: B M
authors.initials: BM
authors.lastname: Ramesh
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.forename: James
authors.initials: J
authors.lastname: Blanchard
authors.forename: Lisa
authors.initials: L
authors.lastname: Avery
mesh_terms: D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D004638:Emergency Treatment / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India; D011247:Pregnancy; D017149:Private Sector; D017150:Public Sector; D011787:Quality of Health Care