Out of Pocket Expenses for Birthing in Public and Private Birthing Facilities Among Women Aged 15 to 49 Years in Bihar, India.

Institutional delivery refers to the birth of a child in public and private health facilities under the supervision of trained, skilled healthcare professionals, thereby enhancing neonatal survival and reducing maternal mortality rates. The low- and middle-income nations continue to have substantial disparities in the proportion of pregnant women accessing healthcare facilities to give safe and healthy births at affordable out-of-pocket (OOP) expenditure. The entire research work aims to analyse the delivery expenses incurred for availing institutional & non-institutional health services and the relationship with socio-demographic factors among women in their reproductive period in Bihar. The entire research work highlights the importance of addressing health to achieve universal coverage; it is a fundamental component for diminishing mother and child mortality and morbidity within the SDGs-3 framework. This research work is solely based on secondary sources compiled from NFHS-5, 2019-21. By applying ArcGIS techniques and statistical tools, such as binary and multivariate logistic regression analysis. The district boundaries of the state have been considered a small unit of Bihar. The overall analysis of the present study reveals that the proportion of institutional delivery increased from 23.1 per cent in NFHS-1 to 55.8 per cent in NFHS-5. The odds ratio for women aged under 20 years was elevated (OR = 1.127, 95% CI = 1.01-1.22, p = 0.03) and higher education of 12 or more years (OR = 5.63, 95% CI = 5.14 - 36.16, p = 0.00) is strongly positively associated with age of mother, place of birth, mother schooling caste and region, indicating that women with average health expenditure are more likely to deliver in public institutions. The odds ratio for women under 20 years was elevated (OR = 1.127, 95% CI = 1.01-1.22, p = 0.03) are out-of-pocket expenses for delivery in private health facilities are much more than in public health facilities, while scheduled caste women (OR = 0.81, 95% CI = 0.76-0.86, p = 0.00) are significantly less probable to incur average health expenditure than women from other castes. The high out-of-pocket expenses act as an economic and psychological burden on mothers during their gestational period.