Factors Impacting Quality of Skilled Birth Attendant Services in Rural India

Availability of skilled birth attendant (SBA) is a crucial factor in reducing mortality rates among mothers and children. The lower- and middle-income countries show low use of these service causing increased risk of maternal and child mortality. While there has been a remarkable improvement in the coverage of SBA-monitored deliveries in India, its impact on outcome indicators such as perinatal and neonatal mortality rates have not been significant. Although the country performs better than the world average in the former, its performance is poor in the latter. This raises question on the quality of SBA services in India. The present study examines SBA services in the context of availability of attendants, infrastructural support and level of training of the SBAs in the rural areas of the four large states in India—Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh. The findings are that SBA lack sufficient training to provide the services effectively. The effectiveness of their services is also hampered by the absence of the essential infrastructure at public health facilities. Moreover, there is congestion and overcrowding at the higher level of facilities such as PHCs and CHCs as compared to village level sub-centres.