Q&A: Understanding facility-based births in LMICs
Published January 16, 2026
There have been major increases in facility-based births in low- and middle-income countries (LMICs) since 1995, and authors of a recent study aimed to understand which facilities met the increased demand. The research, published in eClinicalMedicine, examined the distribution of delivery location by health facility in 130 LMICs from 1995 to 2023 to improve access, quality, and equity.
In 2023, 47.5% of deliveries in LMICs were in public hospitals, 19.2% were in private hospitals, 13.0% were in lower-level public facilities, 2.0% were in private lower-level facilities, and the remaining 18.2% were outside health facilities.
We discuss this research with co-author and IHME Managing Research Scientist Anna Gage.
Transcript
This transcript has been lightly edited for clarity
Q. Why was this study needed?
A. We know that in the past 30 years in low- and middle-income countries, the proportion of women who have gone to a health facility to deliver their baby has increased dramatically, from about 43% in 1995 to 82% in 2023. And we were interested in understanding what types of health facilities have met this increased demand. Are they going to the public sector or the private sector, and are they going to hospitals, those with access to caesarean sections and blood transfusions if necessary? Or are they going to what we call lower-level facilities? Or non-hospitals. And the type of facilities is really important because it has implications for equity, access, and quality of care for women and their newborns.
Q. What are the key findings of the study?
A. We found that public hospitals are really providing a lot of the delivery care for women across many low- and middle-income countries, across all of the countries. In our study, in 2023, 47% of deliveries were happening in public hospitals, about 20% in private hospitals, 13% in public and lower-level, and just 2% in private lower-level, with the remaining occurring outside of health facilities.
We saw that two-thirds of the increase since 1995 in facility deliveries has been borne by public hospitals, really underscoring the important role of these facilities in many countries.
So, this first map is showing the proportion of facility deliveries that are occurring in public hospitals. And we see that a wide variety of countries around the world have a majority of their deliveries occurring in public hospitals. This is especially high proportions in Eastern Europe, Central Asia, parts of Southeast Asia, as well as some countries in Latin America and the Caribbean.
The second map shows the private hospital deliveries as a share of facility deliveries, again in 2023. Here we see a more limited set of countries that have high proportions occurring in private hospitals, including Egypt and Lebanon, as noted earlier, as well as some other countries in the Middle East and South Asia, and select countries in Latin America – such as Pakistan, Argentina, and Ecuador.
Q. What geographical differences did the study reveal?
A. We found pretty stark differences between countries. While in a lot of countries a majority of deliveries happened in public hospitals, that was not the case everywhere. Some notable examples are Egypt and Lebanon, where a majority of deliveries occurred in private hospitals, indicating a large private sector in those countries. And in 12 countries, we found that public lower-level facilities provided a majority of delivery care.
These tended to be countries that had lower socioeconomic development and higher maternal and neonatal mortality rates, showing a non-causal association between place of delivery and mortality.
This chart is showing the trends over time in delivery location across six world regions. The gray here is showing facility deliveries that occur outside of health facilities, while the other colors show the facility types. And we see some dramatic patterns differing by region, with Central Europe, Eastern Europe, and Central Asia having a large proportion occurring in public hospitals throughout the study time frame, whereas other regions have seen much more dramatic increases, such as in South Asia, where the increase in facility delivery has been met by public hospitals as well as private hospitals. In sub-Saharan Africa, we can see this large percentage of women who use public lower-level facilities continuing into 2023.
Q. How do you hope the findings of the study will be used?
A. We think that this study can be helpful in two ways. One is in directing resources to where women currently go, to improve access and improve quality in these dominant types of health facilities in each country. Secondly, we hope that this information can be used to inform normative debates about where women should be going to deliver.
There’s a lot of debate going on right now about should we be using more private sector care or encouraging women to go to hospitals to deliver? And, with this data, we can identify case examples for countries that have undergone some of those transitions and understand what the implications are for equity, access, and equality.