title: Birth preparedness and place of birth in rural Mysore, India: A prospective cohort study.
abstract: BACKGROUND
  India accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India.
  
  
  METHODS
  Between January 2009 and 2011, 1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth.
  
  
  RESULTS
  The median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR]=7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p<0.001) and private institutions (AOR=3.00, p<0.001).
  
  
  CONCLUSIONS
  As a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status.
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, University Park, AHC5-477, Miami FL 33199, USA. Electronic address: mwilc003@fiu.edu.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Wilcox
authors.affiliation: Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India; Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA. Electronic address: kkrup002@fiu.edu.
authors.forename: Karl
authors.initials: K
authors.lastname: Krupp
authors.affiliation: Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: bhavanaskumar@gmail.com.
authors.forename: Bhavana
authors.initials: B
authors.lastname: Niranjankumar
authors.affiliation: Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: drvijaya09@gmail.com.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Srinivas
authors.affiliation: Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: poornima.phri@gmail.com.
authors.forename: Poornima
authors.initials: P
authors.lastname: Jaykrishna
authors.affiliation: Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: anjaliarun87@gmail.com.
authors.forename: Anjali
authors.initials: A
authors.lastname: Arun
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, University Park, AHC5-477, Miami FL 33199, USA; Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 570020, India. Electronic address: pmadhiva@fiu.edu.
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006700:Home Childbirth / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D011247:Pregnancy; D011295:Prenatal Care; D011446:Prospective Studies; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Birth preparedness; India; Institutional birth; Pregnancy; Rural