prospective study of determinants and costs of home births in mumbai slums前瞻性研究家里生产的决定因素和成本在孟买贫民窟.pdfVIP

Das et al. BMC Pregnancy and Childbirth 2010, 10:38 /1471-2393/10/38 RESEARCH ARTICLE Open Access Prospective study of determinants and costs of home births in Mumbai slums 1* 1 1 1 1 2 Sushmita Das , Ujwala Bapat , Neena Shah More , Latika Chordhekar , Wasundhara Joshi , David Osrin Abstract Background: Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth. Methods: As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280 000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models. Results: We described 1708 (16%) home deliveries among 10 754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai), and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted