Road construction programmes that improve access increased the probability of an institutional delivery by 11-13 percent age points in India. However, there was no evidence that increased institutional deliveries improved rates of neonatal mortality or post-birth complications, whether the woman delivered in a public or private facility.
These were the surprising findings of a study published in the British Medical Journal Global Health in July. It indicated that to reduce NMR or to improve maternal health outcomes, it was not sufficient to simply increase the proportion of women delivering in health facilities or in the presence of a skilled health provider.
The study authors suggested that this may be because these facilities were not adequately staffed, trained, or equipped to deliver high-quality health services. They referred to several recent studies that found that even among the cadres of health workers defined as skilled, many did not provide sufficient clinical care, which could be an important barrier to improving clinical outcomes.
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