The Constraints of Distance and Poverty on Institutional Deliveries in Pakistan: Evidence from Georeference-Linked Data

• Published in: Studies in family planning Vol. 46; no. 1; pp. 21 - 39
• Main Authors: Jain, Anrudh K., Sathar, Zeba A., Haque, Minhaj ul
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-03-2015; Wiley Subscription Services, Inc
• Subjects: Access; Adult; Birth; Childbirth & labor; Delivery Systems; Delivery, Obstetric - statistics & numerical data; Emergency medical care; Emergency medical services; Evidence; Family planning; Female; Females; Geographic Information Systems; Gynecology; Health care access; Health care delivery; Health care facilities; Health Care Services; Health facilities; Health Facilities - statistics & numerical data; Health Services Accessibility - statistics & numerical data; Household wealth; Humans; Maternal Health Services - statistics & numerical data; Obstetric labor complications; Obstetrics; Pakistan; Poor; Poverty; Regression analysis; Residence Characteristics - statistics & numerical data; Rural areas; Rural population; Rural Poverty; Social disadvantage; Socioeconomic Factors; Transportation; Travel - statistics & numerical data; Urban Areas; Women; Womens health; Womens health services; Pakistan
• ISSN: 0039-3665; 1728-4465
• DOI: 10.1111/j.1728-4465.2015.00013.x

While institutional deliveries in Pakistan have risen substantially over the last few years, the change has mainly occurred among the wealthy and those with access to services in urban areas. We assess the influence of economic and geographic access to health facilities on institutional deliveries by linking household survey data and georeferenced distance to facilities equipped to provide services for obstetric care in nine districts in Pakistan. Multilevel mixed-effect logistic regression analyses show that the net effect of an increase in distance to a facility by 1 kilometer is to decrease the odds of an institutional delivery by 3 percent. In contrast, household wealth and availability of at least basic emergency care within 10 kilometers substantially increase the odds of an institutional delivery. These effects are more pronounced in rural areas than in urban areas. Disadvantages faced by poor rural women can be minimized by upgrading existing facilities at district and subdistrict levels to provide comprehensive emergency care and by facilitating transportation of poor rural women directly to these facilities when they experience life-threatening complications of childbirth.