Universal health coverage is central to the development agenda to achieve maternal and neonatal health goals. Although there is evidence of a growing preference for institutional births in India, it is important to understand the pattern of switching location of childbirth and the factors associated with it. This study used data from the fourth round of the National Family and Health Survey (NFHS-4) conducted in India in 2015–16. The study sample comprised 59,629 women who had had at least two births in the five years preceding the survey. Bivariate and multivariate logistic regression analyses were applied to the data. About 16.4% of the women switched their location of childbirth between successive births; 9.1% switched to a health facility contributing to a net increment of 1.9% in institutional delivery, varying greatly across states and regions. There was at least a 4 percentage point net increment in institutional births in Chhattisgarh, Bihar, Punjab and Haryana, but the shift was more in favour of home births in Madhya Pradesh, Odisha and West Bengal. Women with high parity and a large birth interval had higher odds of switching their place of childbirth, and this was in favour of a health facility, while women with higher education, from lower social groups, living in urban areas, who had not received four antenatal care visits, and who belonged to a higher wealth quintile had higher odds of switching their place of childbirth to a health facility, despite having lower odds of switching their childbirth location. The study provides evidence of women in India switching their location of childbirth for successive births, and this was more prevalent in areas where the rate of institutional delivery was low. Only a few states showed a higher net increment in favour of a health facility. This suggests that there is a need for action in specific states and regions of India to achieve universal health coverage.

中文翻译：

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连续分娩对分娩地点的偏好是否会发生变化？来自印度各州和地区的证据

全民健康覆盖是实现孕产妇和新生儿健康目标的发展议程的核心。尽管有证据表明印度越来越倾向于机构分娩，但了解转换分娩地点的模式及其相关因素非常重要。本研究使用了 2015-16 年在印度进行的第四轮全国家庭与健康调查 (NFHS-4) 的数据。研究样本包括 59,629 名在调查前五年内至少生育过两次的妇女。对数据应用双变量和多变量逻辑回归分析。约 16.4% 的妇女在连续分娩之间改变了分娩地点；9.1% 转入医疗机构，机构服务净增长 1.9%，各州和地区差异很大。恰蒂斯加尔邦、比哈尔邦、旁遮普邦和哈里亚纳邦的机构分娩净增长至少 4 个百分点，但中央邦、奥里萨邦和西孟加拉邦的家庭分娩更倾向于家庭分娩。胎次高、生育间隔大的妇女转换生育地点的几率更高，这有利于医疗机构，而受过高等教育、来自较低社会群体、生活在城市地区的妇女，她们没有接受过四次产前检查，以及属于较高财富五分之一的人，尽管改变分娩地点的几率较低，但他们将分娩地点转移到医疗机构的几率更高。该研究提供了印度妇女在连续分娩时改变分娩地点的证据，这在机构交付率较低的地区更为普遍。只有少数几个州表现出更高的净增量，有利于医疗机构。这表明有必要在印度的特定州和地区采取行动以实现全民健康覆盖。