title: Institutional deliveries and perinatal and neonatal mortality in Southern and Central India.
abstract: BACKGROUND
  Skilled birth attendance and institutional delivery have been advocated for reducing maternal, perinatal and neonatal mortality (PMR and NMR). India has successfully implemented various strategies to promote skilled attendance and incentivize institutional deliveries in the last 5 years.
  
  
  OBJECTIVE
  The study evaluates the trends in institutional delivery, PMR, NMR, and their risk factors in two Eunice Kennedy Shriver NICHD Global Network for Women's and Children's Health Research sites, in Belgaum and Nagpur, India, between January 2010 and December 2013.
  
  
  METHODS
  Descriptive data stratified by level of delivery care and key risk factors were analyzed for 36 geographic clusters providing 48 months of data from a prospective, population-based surveillance system that registers all pregnant permanent residents in the study area, and their pregnancy outcomes irrespective of where they deliver. Log binomial models with generalized estimating equations to control for correlation of clustered observations were used to test the trends significance
  
  
  RESULTS
  64,803 deliveries were recorded in Belgaum and 39,081 in Nagpur. Institutional deliveries increased from 92.6% to 96.1% in Belgaum and from 89.5% to 98.6% in Nagpur (both p<0.0001); hospital rates increased from 63.4% to 71.0% (p=0.002) and from 63.1% to 72.0% (p<0.0001), respectively. PMR declined from 41.3 to 34.6 (p=0.008) deaths per 1,000 births in Belgaum and from 47.4 to 40.8 (p=0.09) in Nagpur. Stillbirths also declined, from 22.5 to 16.3 per 1,000 births in Belgaum and from 29.3 to 21.1 in Nagpur (both p=0.002). NMR remained unchanged.
  
  
  CONCLUSIONS
  Significant increases in institutional deliveries, particularly in hospitals, were accompanied by reductions in stillbirths and PMR, but not by NMR.
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.forename: Norman
authors.initials: N
authors.lastname: Goco
authors.forename: Manjunath S
authors.initials: MS
authors.lastname: Somannavar
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Vernekar
authors.forename: Ashalata A
authors.initials: AA
authors.lastname: Mallapur
authors.forename: Janet L
authors.initials: JL
authors.lastname: Moore
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Wallace
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Sloan
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
mesh_terms: D000328:Adult; D002423:Cause of Death; D003695:Delivery of Health Care / Q000458:organization & administration / Q000639:trends; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008423:Maternal Age; D054238:Perinatal Mortality / Q000639:trends; D011247:Pregnancy; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult