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Determinants of Skilled Delivery Assistance in a Rural Population: Findings from an HDSS Site of Rural West Bengal, India

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This study examines the determinants of utilisation of skilled birth attendants (SBAs) amongst 2886 rural women in the state of West Bengal, India, using data from a survey of 2012–2013 conducted by the Birbhum Health and Demographic Surveillance System.


Multilevel logit regression models were estimated and qualitative investigations conducted to understand the determinants of utilisation of SBAs in rural West Bengal.


Among women who delivered their last child during the 3 years preceding the survey, 69.1 % of deliveries were assisted by SBAs, while 30.9 % were home deliveries without any SBA assistance. Multivariate analysis revealed that apart from socio-demographic and economic factors (such as household affluence, women’s education, birth order, uptake of comprehensive ANC check-ups, advice regarding danger signs of pregnancy and household’s socio-religious affiliation), supply side factors, such as availability of skilled birth attendants in the village and all-weather roads, have significant effect on seeking skilled assistance. Our findings also show that unobserved factors at village level independently influence uptake of SBA-assisted delivery.

Conclusions for Practice

The present findings emphasise that both demand and supply side intervention strategies are essential prerequisites to enhance skilled birth attendance. Ample communication is observed at the individual level, but improving community level outreach and advocacy activities could generate further demand. SBAs can be better integrated by accommodating the socio-religious needs of local communities, such as providing female doctors and doctors with similar socio-religious backgrounds.

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  1. INDEPTH is a pioneer in health and population research through its global network of health and demographic surveillance system (HDSS) field sites in Africa, Asia and Oceania. INDEPTH produces reliable longitudinal data not only about the lives of people in developing and least developed countries, but about the impact of development policies and programs on those lives.

  2. The Department of Health (DoH), Government of West Bengal funds the HDSS.

  3. Socio-demographic characteristics include proportion of scheduled castes (SCs) and scheduled tribes (STs) population and proportion of urban population. SCs and STs are castes and tribes identified by the Government of India as socioeconomically disadvantaged.

  4. Other geo-physical characteristics of the area include undulating topography, drought and remoteness.

  5. Anganwadi translates to “courtyard shelter” in English. Anganwadi workers are government sponsored health workers chosen from the community and given 4 months training in health, nutrition and child-care. Each Anganwadi worker is expected to cater to a population of 1000 people.

  6. ASHAs are community health workers recruited under the aegis of the National Rural Health Mission (NRHM) implemented by the Ministry of Health and Family Welfare, Government of India.

  7. Likelihood ratio test was carried out for each of the three models respectively to compare them with a simple logit model. The tests justified usage of a multilevel random intercept model.


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We acknowledge contributions from Professor Susanta Bandyopadhyay, Director of Medical Education (Government of West Bengal) and Dr. Biswaranjan Satpathi, Director of Health Services (Government of West Bengal). We would like to express our gratitude to Professor Achin Chakraborty, Director, Institute of Development Studies Kolkata (IDSK) and Professor Abhijit Choudhury, Project Director, SHDS, for their valuable advice. We would like to thank Ashoke Gorain, Survey Manager, SHDS and Saikat Majumdar, Data Manager, SHDS for data collection and compilation. We are also indebted to the anonymous referees for their critical and constructive comments. Finally, the SHDS team deserves special mention for their overall effort in collecting data.

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Correspondence to Saswata Ghosh.

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Ghosh, S., Siddiqui, M.Z., Barik, A. et al. Determinants of Skilled Delivery Assistance in a Rural Population: Findings from an HDSS Site of Rural West Bengal, India. Matern Child Health J 19, 2470–2479 (2015).

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