Private Hospitals in UP–Bihar: Positive Steps, Negative Outcomes in Newborn Care

Private hospitals in the northern Indian states of Uttar Pradesh (UP) and Bihar are associated with alarmingly higher newborn mortality, making the issue a critical public health concern. Although India has made notable progress in reducing infant and maternal deaths over the past two decades, significant regional disparities continue to persist. A recent study conducted by a United States–based research institution, analyzing 77,000 childbirth records, reveals a deeply troubling trend: newborns delivered in private hospitals in UP and Bihar face a 60% higher risk of death compared to those delivered in government hospitals.

This contrast challenges the widespread belief that private healthcare facilities offer superior care and brings attention to the structural and procedural issues within private maternity services in these states. This finding challenges the commonly held belief that private healthcare is better, safer, and more technologically advanced. Instead, the study exposes the harmful consequences of unnecessary medical interventions and profit-driven practices widespread in private healthcare facilities across these states. This article presents a detailed analysis of the study, explores the reasons behind the elevated mortality risk, compares trends across UP and Bihar, and highlights reforms that could potentially save more than 110,000 newborn lives annually.

Understanding the Study and Its Scope

The study investigated 77,000 childbirth cases across districts in Uttar Pradesh and Bihar, representing both rural and semi-urban regions. The data included deliveries occurring in government hospitals, private hospitals, and mixed healthcare settings. Researchers controlled for variables such as maternal age, education, socioeconomic background, antenatal care availability, and proximity to health facilities. The study’s most significant revelation was that private hospitals consistently showed higher neonatal mortality rates, regardless of the mother’s health or family’s economic status.

This indicates that the problem does not lie with the mothers or babies themselves, but with the medical practices and care delivery models used in private centers. Researchers concluded that interventions, procedures, and newborn-handling protocols widely adopted in private facilities were directly responsible for increased mortality.

Unpacking the 60% Higher Neonatal Mortality Risk

A central finding of the study is that private hospitals increase the likelihood of newborn death by nearly 60% when compared to public hospitals. To understand this in real numbers, consider a district where the natural mortality rate is 10 deaths per 1,000 live births. In the presence of private healthcare dominance, this number can rise to around 16 deaths per 1,000. The study further highlights that these outcomes persist irrespective of maternal empowerment, literacy, nutrition, or economic status.

Higher-income and better-educated families, who typically choose private facilities believing they offer superior care, experience worse outcomes compared to poorer families who rely on government hospitals. This statistical effect underscores the systemic nature of the problem: private hospitals are providing care that is unsafe, inconsistent, and medically unjustified, leading to avoidable deaths among newborns.

The Crisis of Unnecessary Medical Interventions

The research identifies a chain of unnecessary interventions routinely imposed on mothers and newborns in private hospitals. These interventions, carried out more for commercial incentives than for clinical need, are the primary contributors to increased mortality. One major issue is the immediate separation of the newborn from the mother. In UP, this separation happens in approximately 35% of private hospital births, and in Bihar the rate is even higher. This is in sharp contrast to government hospitals, where the separation rate is about 25%. Early separation disrupts essential mother–child bonding processes, preventing early breastfeeding, weakening the newborn’s immunity, and increasing the risks of hypothermia and respiratory problems.

Another widespread issue is the misuse of warmers. While warmers are necessary for babies who suffer from low body temperatures, private hospitals frequently place even healthy newborns inside warmers to create a perception of advanced care. Misuse of warmers can result in dehydration, overheating, and respiratory stress. Similarly, immediate bathing of newborns—a dangerous practice linked to hypothermia—is extremely common in private hospitals, despite strong global guidelines recommending the first bath only after 24 hours. Private facilities also administer antibiotics unnecessarily.

These drugs are given even when there are no signs of infection, which can weaken the newborn’s immune system and contribute to long-term antibiotic resistance. Together, these practices demonstrate how private hospitals prioritize profit-driven services rather than evidence-based maternal and neonatal care.

Why Private Hospitals Rely on These Harmful Practices

The root of the problem lies in the business model that governs private healthcare facilities in rural and semi-urban areas of UP and Bihar. Most private hospitals operate with minimal government oversight, which allows unsafe and unscientific practices to flourish. These hospitals generate significant revenue from medical interventions such as C-sections, NICU admissions, warmer usage, diagnostic tests, and antibiotic prescriptions. The more interventions they perform, the higher their profit margins.

Thus, even when a natural birth is possible, many private hospitals push for unnecessary C-sections, leading to complications and delayed breastfeeding. The lack of regulation means that many private facilities run without qualified neonatal specialists, adequate nursing staff, or standard care protocols. In some cases, untrained attendants perform tasks meant for skilled professionals. This unregulated ecosystem puts newborns at enormous risk.

State-Wise Comparison: Uttar Pradesh vs. Bihar

Although both UP and Bihar show similar patterns of higher newborn mortality linked to private hospitals, the severity of the crisis varies between the two states. In Uttar Pradesh, villages with higher private hospital usage consistently reported higher newborn deaths. Around 35% of newborns in private hospitals are separated from mothers shortly after birth, and harmful practices such as early bathing and unnecessary antibiotics are widespread. Bihar, however, presents an even more alarming picture.

The study finds that in Bihar, for every 8% increase in private hospital deliveries, newborn mortality rises by 11 deaths per 1,000 births—a rate far worse than UP. This pattern is especially evident in villages situated on district borders. These villages, while socially and economically similar, exhibit drastically different mortality rates depending on their administrative access to private or public healthcare.

In districts where private healthcare is more easily accessible, families gravitate toward these facilities, resulting in significantly higher newborn deaths due to the flawed practices followed there. Additionally, mother–child separation rates in private facilities in Bihar are even higher than in UP, amplifying health risks.

Why Public Hospitals Deliver Better Outcomes Despite Limitations

The study demonstrates that public hospitals outperform private hospitals in terms of newborn survival, even though government facilities are often understaffed and lack advanced equipment. The primary reason for this is that public hospitals tend to follow natural and evidence-based childbirth practices, which reduce unnecessary medical interference. Government hospitals encourage immediate skin-to-skin contact, early initiation of breastfeeding, and delayed bathing—practices proven to lower newborn mortality.

Unlike private hospitals, public institutions have no financial incentive to perform unnecessary procedures. They follow standardized national guidelines enforced through programs such as LaQshya, Janani Suraksha Yojana, and Janani Shishu Suraksha Karyakram. These programs ensure that childbirth practices are safe, consistent, and closely monitored.

Economic and Social Factors

One of the study’s most surprising findings is that newborns from financially better-off and more educated families often face worse outcomes because these families are more likely to choose private hospitals. Traditionally, higher socioeconomic status correlates with better health outcomes. However, in UP and Bihar, this trend reverses. The issue here is not poverty but misplaced trust in private healthcare. Families assume that private hospitals, because they charge more and appear modern, offer better care.

However, the evidence reveals the opposite. Public hospitals, serving poorer families, provide safer and more natural care, whereas private facilities introduce unnecessary procedures that increase risk. This reversal highlights a structural failure in how healthcare operates in these states.

Potential Lives Saved: The 110,000 Per Year Estimate

Researchers estimate that if private hospitals simply adopt the safe and natural practices used in public hospitals, more than 37,000 newborn lives could be saved annually in UP and Bihar. The numbers become even more dramatic when analyzing the potential impact of families switching from private to government hospitals. If expectant mothers choose government facilities over private ones, the study suggests that over 110,000 newborn lives could be saved every year. This staggering figure underlines the massive harm caused by unsafe private healthcare practices and the urgent need for intervention.

The Larger Healthcare Implications for India

The findings have deep implications for India’s approach to healthcare and regulation. They highlight the dangers of unchecked privatization, especially in regions where regulatory mechanisms are weak. The assumption that private equals better is proving detrimental in poorer states like UP and Bihar, where private health facilities prioritize profit over safety. The results also challenge cultural beliefs that associate technology-driven care with superiority. Families often mistake excess monitoring and machines for quality care, when in reality, natural childbirth practices recommended by global health organizations lead to far better outcomes. The study underscores the need for strong governance, enforcement of clinical standards, and a shift toward evidence-driven maternal and neonatal care.

Policy Recommendations and Solutions

To address the crisis, the study recommends several policy and practice-based reforms. First, there must be strict regulations banning unnecessary interventions such as immediate separation, routine warmer usage, early bathing, and indiscriminate antibiotic administration. Second, governments must enforce licensing and safety standards for private hospitals, including regular audits and penalties for unsafe practices. Third, efforts must be made to promote natural labor processes, including limiting unnecessary C-sections and improving midwife training. Fourth, public awareness campaigns are essential to educate families that expensive care does not guarantee safety. Finally, strengthening public hospitals—through better staffing, infrastructure, and referral systems—can encourage more families to opt for safer childbirth environments.

Long-Term Social and Economic Impact

Reducing newborn mortality has profound consequences for society. Healthier newborns lead to healthier populations, reducing the long-term burden on healthcare systems. Improving maternal and neonatal outcomes also contributes to gender equity, as women experience fewer complications and recover faster. At a broader level, reducing deaths contributes to India’s socioeconomic development by ensuring better survival rates, improving community health, and fostering stronger human capital. The early days of life shape long-term emotional, cognitive, and physical development; therefore, safer childbirth practices influence entire generations.

The study conducted on 77,000 childbirths in Uttar Pradesh and Bihar delivers a powerful message: private hospitals, despite their reputation for better services, are placing newborn lives at greater risk due to their reliance on unnecessary and harmful medical interventions. A 60% higher neonatal mortality rate is not just a statistic—it represents thousands of avoidable tragedies. The evidence clearly shows that public hospitals, with their standardized and natural care practices, offer safer environments for childbirth.

If private hospitals adopt similar practices or if mothers choose public hospitals instead, over 110,000 newborn lives could be saved every year. Addressing this issue requires urgent government action, regulatory reforms, and increased public awareness. The path to safer childbirth lies not in more expensive care, but in evidence-based, natural, and compassionate care that prioritizes the well-being of both mother and child.