Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 29;23(1):50.
doi: 10.1186/s12916-025-03894-6.

Private sector delivery of care for maternal and newborn health: trends over a decade in the Indian state of Bihar

G Anil Kumar  1 , Sibin George  1 , Moutushi Majumder  1 , S Siva Prasad Dora  1 , Md Akbar  1 , Tanmay Mahapatra  2 , Rakhi Dandona  3   4
Affiliations

Private sector delivery of care for maternal and newborn health: trends over a decade in the Indian state of Bihar

G Anil Kumar et al. BMC Med. .

Abstract

Background: We synthesised the current evidence in coverage and quality of delivery care, change in neonatal mortality (NMR), and causes of neonatal death in the private sector deliveries in the Indian state of Bihar from 2011 to 2021.

Methods: Women aged 15-49 years with livebirths were interviewed in three household surveys involving state-representative samples in 2011, 2016 and 2020-2021 designed to document the coverage of maternal and newborn health services and change in NMR over time. Verbal autopsy interviews were used to assign the cause of neonatal death. The coverage of private sector facilities for livebirths in each survey and the percent change over time by 38 districts in the state and select socio-demographic characteristics, along with trends in NMR and causes of neonatal death across years are reported.

Results: Private sector delivery coverage was 17.3% (95% CI = 16.6-17.9), 16.7% (95% CI = 16.2-17.2) and 26.1 (95% CI = 25.6-26.6) in 2011, 2016 and 2020-2021, respectively. A significant increase of 56.3% (95% CI = 49.3 to 63.3) in this coverage was documented between 2016 and 2020-2021 with the highest increase in the lowest wealth index quartile in urban areas. The district-wise coverage of private sector delivery ranged from 4.6% to 34.9%, 5.5% to 40.7%, and 5.9% to 62.0% in 2011, 2016 and 2020-2021, respectively. NMR was estimated at 41.3 (95% CI = 31.4-51.2), 36.6 (95% CI = 29.4-43.8), 38.6 (95% CI = 34.4-43.3) per 1000 livebirths in 2011, 2016 and 2020-2021, with no significant change over the years. Birth asphyxia was the leading cause of death in 2016 (37.8%) and 2020-2021 (33.9%) followed by preterm delivery and neonatal pneumonia; a statistically significant reduction was seen in meningitis/sepsis between 2016 and 2020-2021 (77.8%; 95% CI = - 145.4 to - 10.1).

Conclusions: This analysis contributes to a nuanced understanding of the changes in the private sector delivery in a given population over time to facilitate appropriate actions and interventions to improve newborn survival and maternal services.

Keywords: Bihar; Cause of neonatal death; India; Maternal; Neonatal mortality; Newborn; Private sector; Quality; Services.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The surveys were approved by the Institutional Ethics Committee of the Public Health Foundation of India (study numbers TRC-IEC 104/11, TRC-IEC 327/17 and TRC-IEC 462/21). Participants gave informed consent to participate in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Coverage of private sector delivery by district in the Indian state of Bihar in the survey of 2011, 2016 and 2020–2021* (weighted coverage)
Fig. 2
Fig. 2
Comparative distribution of causes of neonatal death for private sector deliveries in the surveys of 2016 and 2020–2021
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. World Health Organization. Engaging the private health service delivery sector through governance in mixed health systems: strategy report of the WHO Advisory Group on the Governance of the Private Sector for Universal Health Coverage. Geneva: WHO; 2020.
    1. Kruk ME, Gage AD, Joseph NT, Danaei G, Garcia-Saiso S, Salomon JA. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet. 2018;392:2203–12. - PMC - PubMed
    1. Chou VB, Walker N, Kanyangarara M. Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study. PLoS Med. 2019;16(12): e1002990. - PMC - PubMed
    1. Benova L, Macleod D, Footman K, Cavallaro F, Lynch CA, Campbell OM. Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys. Tropical Med Int Health. 2015;20(12):1657–73. - PubMed
    1. Campbell OM, Benova L, MacLeod D, Baggaley RF, Rodrigues LC, Hanson K, Powell-Jackson T, Penn-Kekana L, Polonsky R, Footman K, et al. Family planning, antenatal and delivery care: cross-sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low- and middle-income countries. Tropical Med Int Health. 2016;21(4):486–503. - PubMed

LinkOut - more resources