skilled attendance at delivery and postnatal care.

Methods
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Study site
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Madhya Pradesh is the second largest state in India with an area of 308,000 square kilometers. The state accounts for 9.4% of India\'s geographical area. According to the provisional figures of 2011 census, population of the state is 72,597,565. The decadal growth rate of population in Madhya Pradesh during 2001-2011 was 20.3% which was higher than that of India (17.64%). Population density of the state is 236 persons per square kilometer as against 382 for the country \[[@B16]\]. The population of the state is primarily rural with only 26.7% residing in urban areas. The state has 20.3% tribal and 16% scheduled cast population \[[@B17]\]. The state is one of the poorest six states of India and around 38% population of thestate was living below poverty line in 2004-2005 \[[@B18]\].

The state comprises of 55,393 villages, 313 development blocks and 50 administrative districts. There are huge geographical, social, economic and cultural variations between and within districts \[[@B19]\]. The responsibilities of health care services lie with the department of public health and family welfare of the state government. In 2008, there were 270 community health centres, 1149 primary health centres and 8,834 health sub centres in the state to provide preventive and curative health care services in rural areas \[[@B20]\]. The state also has a huge network of private sector health care facilities which are mainly concentrated in urban areas.

Study design and sampling technique
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This study was designed as a cross sectional study. The data was derived from the District Level Household