Is emergency birth preparedness associated with increased skilled care at birth? Evidence from rural Uttar Pradesh, India

Background: Emergency birth preparedness has been promoted to address delays in seeking skilled care at birth. However, little evidence is available for the effectiveness of birth preparedness in the context of large scale programs. This analysis uses data from the evaluation of a community-based maternal and newborn care program in rural India to examine the association between birth preparedness and use of a skilled birth attendant. Methods: Community-based workers counseled pregnant women on maternal and newborn care, including four emergency birth preparedness steps: 1) identifying a health facility, 2) identifying a person to accompany the mother, 3) arranging for transport, and 4) saving money. Logistic regression was used to assess the association between taking any emergency birth preparedness step and using a skilled birth attendant. Results: Of the 8,069women who gave birth during 2004-2005, 51.8% (n =4,183) took at least one emergency birth preparedness step. In the adjusted analysis, women who took at least one birth preparedness step were 45% more likely to have skilled care at birth [OR: 1.45; 95% CI: 1.30-1.63]. Conclusions: Promoting emergency birth preparedness in community-based maternal and newborn care programs may increase the utilization of skilled birth attendants.