Impact of socio-economic inequity in access to maternal health benefits in India: Evidence from Janani Suraksha Yojana using NFHS data

Abstract

Background Caste plays a significant role in Indian society and it influences women to health care access in the community. The implementation of the maternal health benefits scheme in India is biased due to caste identity. In this context, the paper investigates access to Janani Suraksha Yojana (JSY) among social groups to establish that caste still plays a pivotal role in Indian society. Also, this paper aims to quantify the discrimination against Scheduled Castes/Scheduled Tribes (SCs/STs) in accessing JSY. Methods This paper uses a national-level data set of both NFHS-3 (2005–06) and NFHS-4 (2015–16). Both descriptive statistics and the Fairlie decomposition econometric model have been used to measure the explained and unexplained differences in access to JSY between SCs/STs and non-SCs/STs groups. Results Overall, the total coverage of JSY in India is still, 36.4%. Further, it is found that 72% of access to JSY is explained by endowment variables. The remaining unexplained percentage (28%) indicates that there is caste discrimination (inequity associated social-discrimination) against SCs/STs in access to JSY. The highest difference (54%) between SCs/STs and non-SCs/STs in access to JSY comes from the wealth quintile, with the positive sign indicating that the gap between the two social groups is widening. Discussion and conclusion It is necessary for the government to implement a better way to counter the caste-based discrimination in access to maternal health benefits scheme. In this regard, ASHA and Anganwadi workers must be trained to reduce the influence of dominant caste groups as well as they must be recruited from the same community to identify the right beneficiaries of JSY and in order to reduce inequity associated with social-discrimination.

Evaluasi Capaian Peta Jalan JKN di Provinsi Bengkulu Studi Kasus Sectio Caesarea Tahun 2014 Sampai 2019

“…Orang yang tinggal di perkotaan memiliki kecenderungan lebih besar untuk mengakses fasilitas kesehatan dibandingkan kelompok miskin (Nababan, Hasan, Marthias, & et.al, 2018). Hal ini tentu didukung dari aspek demand side maupun supply side (Mishra, Veerapandian, & Choudhary, 2021). Harus dipahami akan selalu ada variasi dalam penyediaan pelayanan kesehatan yang tidak bisa didistribusikan secara merata antar daerah maupun antar kelompok.…”

Institutional deliveries in India’s nine low performing states: levels, determinants and accessibility

“…Majority of these preventable maternal deaths (about 94%) occur in resource-constrained settings of LMICs [ 1 ]. Although India has made considerable progress in reducing maternal mortality over the past years (from 556 deaths per 100,000 live births in 1990 to 113 deaths per 100,000 live births in 2018), it remains alarmingly high in low performing states (LPS) (161 deaths per 100,000 live births) [ 5–8 ]. The LPS in India include Assam and eight Empowered Action Group (EAG) states (i.e.…”

“…Despite several national and state-specific policy initiatives and implementation measures, disparity prevails across sub-national regions regarding utilization of essential maternal healthcare services resulting in failure to achieve the National Health Policy 2017 target of reducing maternal mortality ratio (MMR) to 100 deaths per 100,000 live births [ 5 , 8–10 ]. Safe delivery care (Institutional delivery/delivery by skilled health attendant [SBA]) is an important component of the continuum of maternal healthcare that averts preventable maternal and neonatal deaths with adequate health-seeking and good quality of care [ 11 ].…”

“…Safe delivery care (Institutional delivery/delivery by skilled health attendant [SBA]) is an important component of the continuum of maternal healthcare that averts preventable maternal and neonatal deaths with adequate health-seeking and good quality of care [ 11 ]. Although India’s achievements toward utilization of institutional delivery services have been substantial over the years (increased from 41% in 2005–06 to 79% in 2015–16) with large-scale public health investments, studies suggest that usage of facility-based skilled delivery care is uneven across states, socio-economic strata, and rural-urban residence [ 5 , 6 , 12–15 ]. A large amount of expenditure incurred at the point of healthcare use through high out-of-pocket payments (OOPs) and associated catastrophic health expenditure (CAH) (increased from 11% in 1995 to 25% in 2014) hinder beneficiaries (especially from marginalized communities) from delivering at health facilities and forcing them to uptake unsafe home deliveries [ 6 , 16 , 17 ].…”

“…Whilst post-JSY scheme implementation, institutional delivery service has been widely utilized in India with extensive monetary assistance from the government, several beneficiaries still find accessing the JSY scheme challenging and unhelpful (sometimes with untimely cash disbursement) [ 5 , 23 , 27 , 28 ]. Hence, even a decade later institutional delivery services and utilization of JSY remain unequal and uneven within states and regions where beneficiaries still struggle to access the healthcare facilities due to insufficient logistic support and suffer from discriminatory/unsatisfactory (poor) quality of care at public healthcare facilities [ 23 , 29 , 30 ].…”