Inequalities in the utilisation of maternal health Care in Rural India: Evidences from National Family Health Survey III & IV

Abstract

Background: Since the implementation of National Rural Health Mission (NRHM) in 2005, Maternal Mortality Ratio has significantly declined in India through a noticeable improvement in maternal health care services. However, India did not succeed to achieve the target of millennium development goal to reduced maternal mortality ratio by 2015. Also, there is substantial inequality exist at the regional, geographic, economic, and social level, and various socioeconomic factors contribute to the significantly large share in inequality in utilisation of maternal health care in India. Methods: Using data from the National Family Health Survey (2005 and 2015), this study examined the degree of inequality exist in maternal health care namely full antenatal care (full ANC), skilled attendants at birth (SBA), and postnatal care (PNC) in rural India. Descriptive statistics, concentration index (CI), and Wagstaff decomposition method have been performed to understand the pattern of maternal health care utilisation, and to explain the extent of inequality in maternal health care utilisation. Results: The study revealed that a substantial gap across socioeconomic groups exist in utilisation of maternal health care has significantly reduced in rural India during 2005-16. The results found a noticeable improvement in maternal health care utilisation, especially in utilisation of skilled attendants at birth (SBA). During this decade, the concentration index for SBA showed a significant decline from 0.28 in 2005-06 to 0.09 in 2015-16, while that of full ANC declined from 0.47 to 0.32 over the same period, and reduction of inequality in full ANC was least. Further, the results of decomposition analysis suggested that secondary and higher education, mass media exposure, and scheduled tribe contributed a significant share to the inequality. Conclusion:The exposure to mass media is the most significant contributor to inequality, and hence, there is a need for broad dissemination of awareness regarding maternal health care schemes in rural parts of country. Based on findings of study, it is suggested that health scheme related to maternal and child health care under NRHM be continued and focused for lower socioeconomic groups and marginalized mothers to reduce maternal health services inequality, particularly in the component of full ANC.

Maternal Health Care Service Utilization Among Young Married Women in India, 1992-2016: Trends and Determinants

“…In our study, young women with no exposure to any kind of mass media were found to be less likely to use full ANC and SBA. This result concurs with the ndings from various other studies in which exposure to mass media had a positive association with the utilization of maternity care services [47,61,71,72]. Mass media is an important source of information on health and existing health care programs or policies.…”

“…Concerning birth order, the likelihood of using full ANC and SBA decreases signi cantly with the increase in birth order. Several other studies have reported similar nding [38,40,47,69]. Primiparous women may have fear of rst pregnancy and are more afraid of complications and di culties during delivery.…”

“…Regarding the social group, young women belonging to other than SC/ST group were more likely to use both the maternal health care services. Several studies from India [40,46,47] and other countries [36,37,48,49] showed that the utilization of maternity care services is affected by ethnicity and religion of women. Religion-speci c beliefs and traditional practices of Muslim women may lead to lower use of maternity care services among them [50].…”

Monitoring the decomposition of wealth-related inequality in the use of regular antenatal care in Egypt (1995–2014)

“…As in the literature on determinants of antenatal care use in developing countries , research in Egypt has confirmed the importance of both social and health needs as determinants of antenatal care [14,18,19,25,27]. On the social side, women's age or age at birth, their education, their husbands' education level, the women's work status, the household standard of living/wealth, and place of residence, assessed in terms of regional level or by rural/urban differentiation, were identified as significant determinants of antenatal care [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][31][32][33][34]. On the health dimension, most research highlighted the significant contribution of parity/birth order, previous birth experience, attributes of current pregnancy (in particular preceding birth interval), the survival status of the previous birth, and the experience of a terminated pregnancy [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]…”

“…Other research efforts focused on monitoring changes in the use of antenatal care over time [27,29]. Modeling any use of antenatal care separately for the years 2000 and 2014, Zaky and colleagues showed that wealth, higher education attainment of both women and their husbands, and residence in frontier governorates were significantly related to the use of any antenatal care in 2000 [29]. However, most of these determinants had lost their significance, in particular education and regional differences, by 2014.…”