Supply-side barriers to maternity-care in India: a facility-based analysis

PLoS One. 2014 Aug 5;9(8):e103927. doi: 10.1371/journal.pone.0103927. eCollection 2014.


Background: Health facilities in many low- and middle-income countries face several types of barriers in delivering quality health services. Availability of resources at the facility may significantly affect the volume and quality of services provided. This study investigates the effect of supply-side determinants of maternity-care provision in India.

Methods: Health facility data from the District-Level Household Survey collected in 2007-2008 were analyzed to explore the effects of supply-side factors on the volume of delivery care provided at Indian health facilities. A negative binomial regression model was applied to the data due to the count and over-dispersion property of the outcome variable (number of deliveries performed at the facility).

Results: Availability of a labor room (Incidence Rate Ratio [IRR]: 1.81; 95% Confidence Interval [CI]: 1.68-1.95) and facility opening hours (IRR: 1.43; CI: 1.35-1.51) were the most significant predictors of the volume of delivery care at the health facilities. Medical and paramedical staff were found to be positively associated with institutional deliveries. The volume of deliveries was also higher if adequate beds, essential obstetric drugs, medical equipment, electricity, and communication infrastructures were available at the facility. Findings were robust to the inclusion of facility's catchment area population and district-level education, health insurance coverage, religion, wealth, and fertility. Separate analyses were performed for facilities with and without a labor room and results were qualitatively similar across these two types of facilities.

Conclusions: Our study highlights the importance of supply-side barriers to maternity-care India. To meet Millennium Development Goals 4 and 5, policymakers should make additional investments in improving the availability of medical drugs and equipment at primary health centers (PHCs) in India.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Competence / statistics & numerical data
  • Delivery of Health Care / statistics & numerical data
  • Delivery, Obstetric* / standards
  • Delivery, Obstetric* / statistics & numerical data
  • Drugs, Essential / therapeutic use
  • Female
  • Health Services Accessibility* / statistics & numerical data
  • Hospital Bed Capacity / standards
  • Hospital Bed Capacity / statistics & numerical data
  • Humans
  • India / epidemiology
  • Maternal Health Services* / standards
  • Maternal Health Services* / supply & distribution
  • Pregnancy
  • Quality of Health Care
  • Socioeconomic Factors


  • Drugs, Essential

Grants and funding

This project was funded by the Disease Control Priorities Network grant to the Institute for Health Metrics and Evaluation from the Bill & Melinda Gates Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.