Institutional Deliveries and Public Health Infrastructure in Assam: A District-level Correlation based on NFHS-5 Data

Institutional delivery is a critical marker of maternal health outcomes.While the availability of healthcare facilities is a precondition for increasing institutional deliveries, it does not necessarily ensure their utilization.The present study attempted to examine the relationship between the institutional delivery rates and the availability of public health institutions across the districts of Assam.Using secondary data available on the Fifth National Family Health Survey (2019-2021) and the Statistical Handbook Assam (2020), a two-tailed Pearson correlation analysis was carried out.It was found that the two variables have a very weak and statistically insignificant linear relationship (r = 0.009, p = 0.960).This means that just increasing the number of health institutions does not guarantee that more women will give birth in those facilities.Thus, the findings revealed the need to look beyond infrastructure quantity to other factors like quality of care, physical and financial accessibility, education and awareness, sociocultural norms, and women's decision-making autonomy to improve maternal health outcomes.Amartya Sen's capability approach helps in interpreting these findings: While the presence of health institutions may represent "available resources, " but what truly matters is the freedom and ability of women to convert that resource into actual functioning, i.e., a safe and supported institutional delivery.Therefore, future government health planning regarding maternal care should adopt a broader, gender-sensitive, and context-specific approach.