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Understanding High Mortality among Private Facility Births in Rural Uttar Pradesh
In the last 15 years, there has been a large increase in facility births and a large decline in home births across India. In Uttar Pradesh, increases in facility birth have led to puzzlingly little decline in neonatal mortality. This paper investigates the role of private facilities in providing care at birth to rural residents of UP. Approximately one in five births of rural UP residents takes place in a private facility. These births experience a stunningly high neonatal mortality rate of 53 deaths per 1,000, compared to 32 among births in public facilities, and 40 among home births. This research seeks to understand why mortality rates are higher in private facilities than public facilities.
The authors thank Dean Spears, Nathan Franz, Sangita Vyas, Payal Hathi, Aashish Gupta, Kanika Sharma, and Alok Kumar for conversations informing their interpretations and for commenting on drafts of this paper. They also thank the anonymous reviewer for helpful feedback.
Despite recent increases in facility births, maternal and newborn health outcomes in Uttar Pradesh (UP) remain exceptionally poor. The state’s overall neonatal mortality rate (NNM) was 48 deaths per 1,000 live births in 2005 and 36 per 1,000 in 2019, making it the state with the highest NNM in both years. The rural NNM was even higher, at 49 in 2005 and 38 in 2019. The 2016–18 SRS Bulletin on Maternal Mortality reported that UP had the second highest maternal mortality ratio (MMR; maternal deaths per 1,00,000 live births) of any state after Assam, at 197 (ORG 2020). These high mortality rates mean that the state contributes a disproportionate share of India’s maternal and newborn deaths: 27% of India’s neonatal deaths and more than 35% of maternal deaths occur in UP, compared to only 18% of births.1 Considering that UP accounts for a disproportionately large share of India’s maternal and neonatal mortality, understanding its maternal and newborn health services is critical to improving health in the country as a whole.2
Health researchers have noted that the private sector plays a major role in healthcare in UP. Indeed, Jain et al (2015) analyse the 71st round of the National Sample Survey Office (NSSO) and find that 85% of outpatient care and about 70% of inpatient care in UP was provided by the private sector. Maternal and newborn health services are an exception: more births occur in public facilities than in private facilities.
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