title: Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys.
abstract: OBJECTIVE
  Maternal mortality rates have decreased globally but remain off track for Millennium Development Goals. Good-quality delivery care is one recognised strategy to address this gap. This study examines the role of the private (non-public) sector in providing delivery care and compares the equity and quality of the sectors.
  
  
  METHODS
  The most recent Demographic and Health Survey (2000-2013) for 57 countries was used to analyse delivery care for most recent birth among >330 000 women. Wealth quintiles were used for equity analysis; skilled birth attendant (SBA) and Caesarean section rates served as proxies for quality of care in cross-sectoral comparisons.
  
  
  RESULTS
  The proportion of women who used appropriate delivery care (non-facility with a SBA or facility-based births) varied across regions (49-84%), but wealth-related inequalities were seen in both sectors in all regions. One-fifth of all deliveries occurred in the private sector. Overall, 36% of deliveries with appropriate care occurred in the private sector, ranging from 9% to 46% across regions. The presence of a SBA was comparable between sectors (≥93%) in all regions. In every region, Caesarean section rate was higher in the private compared to public sector. The private sector provided between 13% (Latin America) and 66% (Asia) of Caesarean section deliveries.
  
  
  CONCLUSIONS
  This study is the most comprehensive assessment to date of coverage, equity and quality indicators of delivery care by sector. The private sector provided a substantial proportion of delivery care in low- and middle-income countries. Further research is necessary to better understand this heterogeneous group of providers and their potential to equitably increase the coverage of good-quality intrapartum care.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Lenka
authors.initials: L
authors.lastname: Benova
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Macleod
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Katharine
authors.initials: K
authors.lastname: Footman
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cavallaro
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Lynch
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Oona M R
authors.initials: OM
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D001208:Asia; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards*; D003906:Developing Countries; D005060:Europe; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D007843:Latin America; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008428:Maternal Mortality; D008875:Middle Aged; D008877:Middle East; D008880:Midwifery; D011247:Pregnancy; D017149:Private Sector; D017150:Public Sector; D012923:Social Class; D055815:Young Adult
keywords: Caesarean section; Demographic and Health Surveys; delivery care; multicountry analysis; private sector; skilled birth attendant