Over the past two decades, multilateral organizations have encouraged increased engagement with private health care providers in developing countries. As these efforts progress, there are concerns that private delivery care may have adverse effects on maternal health. Currently available data do not allow for an in-depth study of the direct effect of privatization on maternal health. However, as a first step, we can use Demographic and Health Surveys (DHS) data to examine a) trends in growth of delivery care provided by private facilities, and b) determinants of private sector use within the health care system. To construct trends, this study uses DHS from 16 sub-Saharan African, Asian, and Latin American countries, selecting those countries with one DHS in phase 4 (1997–2003) and one in phase 5 (2003–present).
For a subset of eight countries, we examine determinants of a mother’s choice to deliver in a health facility and then, among women delivering in a facility, their decision to use a private provider. Determinants of use are grouped by socioeconomic characteristics, economic and physical access and by actual/perceived need.
Results show a significant trend toward privatization of delivery care over the 13 years covered in the study but there is considerable variation in the characteristics driving this increased use across countries. In three African countries, socio-demographic characteristics are associated with use of private delivery care, while in Bolivia and four Asian countries, economic indicators are more relevant. In the former this may suggest complementarity to public facilities (e.g. private delivery services cover populations that may not be reached by public services), while in the latter it may mean competition. These results warn against making generalizations on the effects of privatization on maternal health use.