title: Determinants of Skilled Delivery Assistance in a Rural Population: Findings from an HDSS Site of Rural West Bengal, India.
abstract: OBJECTIVE
  This study examines the determinants of utilisation of skilled birth attendants (SBAs) amongst 2886 rural women in the state of West Bengal, India, using data from a survey of 2012-2013 conducted by the Birbhum Health and Demographic Surveillance System.
  
  
  METHODS
  Multilevel logit regression models were estimated and qualitative investigations conducted to understand the determinants of utilisation of SBAs in rural West Bengal.
  
  
  RESULTS
  Among women who delivered their last child during the 3 years preceding the survey, 69.1 % of deliveries were assisted by SBAs, while 30.9 % were home deliveries without any SBA assistance. Multivariate analysis revealed that apart from socio-demographic and economic factors (such as household affluence, women's education, birth order, uptake of comprehensive ANC check-ups, advice regarding danger signs of pregnancy and household's socio-religious affiliation), supply side factors, such as availability of skilled birth attendants in the village and all-weather roads, have significant effect on seeking skilled assistance. Our findings also show that unobserved factors at village level independently influence uptake of SBA-assisted delivery.
  
  
  CONCLUSIONS
  The present findings emphasise that both demand and supply side intervention strategies are essential prerequisites to enhance skilled birth attendance. Ample communication is observed at the individual level, but improving community level outreach and advocacy activities could generate further demand. SBAs can be better integrated by accommodating the socio-religious needs of local communities, such as providing female doctors and doctors with similar socio-religious backgrounds.
authors.affiliation: Institute of Development Studies Kolkata (IDSK), DD-27/D, Sector-1, Near City Centre, Salt Lake City, 700 064, Kolkata, India. ghosh.saswata@gmail.com.
authors.forename: Saswata
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Crawford School of Public Policy, Australian National University, Acton, ACT, Australia. zakaria.jnu@gmail.com.
authors.forename: Md Zakaria
authors.initials: MZ
authors.lastname: Siddiqui
authors.affiliation: Society for Health and Demographic Surveillance (SHDS), Suri, Birbhum, India. anomitro2010@gmail.com.
authors.forename: Anamitra
authors.initials: A
authors.lastname: Barik
authors.affiliation: Society for Health and Demographic Surveillance (SHDS), Suri, Birbhum, India. sunilbhaumik.09@gmail.com.
authors.forename: Sunil
authors.initials: S
authors.lastname: Bhaumik
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D016015:Logistic Models; D008880:Midwifery; D015999:Multivariate Analysis; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Birbhum HDSS; Multilevel modelling; Skilled birth attendant; Supply side factors; Unobserved heterogeneity