Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys

Trop Med Int Health. 2015 Dec;20(12):1657-73. doi: 10.1111/tmi.12598. Epub 2015 Sep 28.


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.

Conclusion: 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.

Keywords: Caesarean section; Demographic and Health Surveys; delivery care; multicountry analysis; private sector; skilled birth attendant.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Asia
  • Cesarean Section
  • Cross-Sectional Studies
  • Delivery, Obstetric / methods
  • Delivery, Obstetric / standards*
  • Developing Countries*
  • Europe
  • Female
  • Health Services Accessibility*
  • Humans
  • Income
  • Latin America
  • Maternal Health Services / standards*
  • Maternal Health Services / statistics & numerical data
  • Maternal Mortality
  • Middle Aged
  • Middle East
  • Midwifery*
  • Pregnancy
  • Private Sector*
  • Public Sector*
  • Social Class
  • Young Adult