NEW DELHI: Institutional deliveries in India have seen a hike, but home deliveries continue to be a norm, especially in the north-east and some north Indian states like Uttar Pradesh, Uttarakhand and Delhi in 2021-22, as per the latest health ministry data.
Three states, including Telangana and Tamil Nadu, and two union territories, reported hundred per cent institutional deliveries in 2021-22, while nine states, including Karnataka, Kerala, Andhra Pradesh, Gujarat, and Maharashtra, saw over 99 per cent births in institutes.
Puducherry and Lakshadweep are the two union territories that saw one hundred per cent institutional deliveries in the same period.
| States | Institutional delivery (2021-22) |
| Tamil Nadu | 100 per cent |
| Telangana | 100 per cent |
| Goa | 100 per cent |
| Puducherry | 100 per cent |
| Lakshadweep | 100 per cent |
| Karnataka | 99.9 per cent |
| Kerala | 99.9 per cent |
| Andhra Pradesh | 99.9 per cent |
| Gujarat | 99.8 per cent |
| Dadra and Nagar Haveli and Daman and Diu | 99.6 per cent |
| Sikkim | 99.5 per cent |
| Maharashtra | 99.4 per cent |
| Punjab | 99 per cent |
| All India | 95.5 per cent |
However, there cause for concern is that states like Meghalaya, Nagaland, Manipur, Bihar, Uttarakhand, Mizoram, Assam, Uttar Pradesh, Arunachal Pradesh, Himachal Pradesh, Tripura, Jammu and Kashmir and Delhi in 2021-22 have reported home deliveries more than the national average of 4.5 per cent.
In 2020-21, also, these 13 states reported a high number of home deliveries, more than the all-India percentage of 5.2 per cent, according to the latest report of the Health Management Information System (HMIS), which is a complete source of information for facility level health data nationwide.
Experts said institutional deliveries are important to reduce Maternal Mortality Ratio (MMR) in India and home delivery is still happening because hospitals are still not readily accessible in far-fetched areas. MMR in India has declined from 130 in 2014-16 to 97 in 2018-20.
Institutional deliveries in India increased from 70.6 per cent in 2008-09 to 95.5 per cent in 2021-22. In 2021-22, only Meghalaya saw 57.2 per cent of institutional deliveries. In 2020-21, only Tamil Nadu, Puducherry and Lakshadweep had achieved hundred per cent institutional deliveries.
Though home delivery saw a slight dip in the last two years, two states – Meghalaya and Arunachal Pradesh – saw a hike last year. While in 2020-21, home delivery in Meghalaya was 40.6 per cent, it went up to 42.8 per cent in 2021-22.
Similarly, in Arunachal Pradesh, home delivery was 8.8 per cent. It touched 9.4 per cent last year.
Surprisingly, Delhi also figures among the 13 states where home delivery is still occurring. Though, there is a slight dip in percentage. In 2020-21, the figure stood at 5.4 per cent, it was 4.7 per cent in 2021-22.
| States | Home Delivery (2021-22) |
Meghalaya | 42.8 per cent |
| Nagaland | 21.7 per cent |
| Manipur | 19.4 per cent |
| Bihar | 13.3 per cent |
| Uttarakhand | 11.5 per cent |
| Mizoram | 12.8 per cent |
| Assam | 8.7 per cent |
| Uttar Pradesh | 8.8 per cent |
| Arunachal Pradesh | 9.4 per cent |
| Himachal Pradesh | 7.3 per cent |
| Tripura | 5.4 per cent |
| Jammu and Kashmir | 5.1 per cent |
| Delhi | 4.7 per cent |
| All India | 4.5 per cent |
In India, 1067470 home deliveries were reported in 2020-21 and 922637 in 2021-22.
“The maternal delivery at home without skilled care at birth is a major public health issue. Maternal death is a severe public health problem where home delivery without skilled care at birth has a significant detrimental impact,” said the HMIS analytical report.
“Most importantly, as women die from preventable causes during childbirth, non-institutional or home delivery needs to be eliminated. Sustainable Development Goal 3 (SDG-3) targets: “reducing the global MMR to less than 70 per 100,000 births, with no country having a maternal mortality rate of more than twice the global average,” the report further added.
Prof. Dileep Mavalankar, Director, Indian Institute of Public Health (IIPHs), Gandhinagar, Gujarat, said home delivery happens in places where hospital delivery is not easily accessible or not affordable. Also, women prefer home delivery due to tradition or fear of caesarean section or instrumental delivery.
“To reduce MMR further, we need to improve emergency obstetric services and availability of blood transfusion at Community Health Centres or sub-district level,” Mavalankar, an expert on maternal health, told TNIE.
Dr S. Shantha Kumari, past president of the Federation of Obstetric and Gynecological Societies of India (FOGSI), told TNIE that institutional deliveries are essential to reduce MMR and home deliveries are still happening due to socio-economic and cultural barriers in northeast states, and rugged hilly terrain where medical facilities are not readily available.
“The review of HMIS data in India shows that despite major initiatives taken by the government in the last ten years, some states still show high home deliveries,” the report added.