The Burden of Maternal Health Care Expenditure in India: Multilevel Analysis of National Data

Leone, Tiziana; James, K. S.; Padmadas, Sabu S.

doi:10.1007/s10995-012-1174-9

Cited by 50 publications

(56 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The utilization of maternal health care can further be driven by multilevel factors, such as those operating at the individual, community, and district levels [5,11–13]. Cultural norms within the community or district, for example, can hinder a woman from seeking or receiving health care.…”

Section: Introductionmentioning

confidence: 99%

Towards an understanding of the multilevel factors associated with maternal health care utilization in Uttar Pradesh, India

Sridharan

Dey

Seth

et al. 2017

Global Health Action

View full text Add to dashboard Cite

Background: This paper explores the multilevel factors associated with maternal health utilization in India’s most populous state, Uttar Pradesh. 3 key utilization practices: registration of pregnancy, receipt of antenatal care, and delivery at home are examined for district and individual level predictors. The data is based on 5666 household surveys conducted as part of a baseline evaluation of the Uttar Pradesh Technical Support Unit (UPTSU.) program. Objectives: This intervention aims to assist the Government of Uttar Pradesh in increasing the efficiency, effectiveness, and equity of service delivery across a continuum of reproductive, maternal, new-born, child, and adolescent health (RMNCH+A) outcomes. Methods: The paper employs multilevel models that control for individuals being nested within districts in order to understand the predictors of maternal health care utilization. Results: The study identifies several individual-level predictors of health care utilization, including: literacy of the woman, the husband’s schooling, age at marriage, and socio-economic factors. Key predictors of pregnancy registration include husband’s schooling (OR 1.49, 95% CI 1.26–1.76), having a bank account (OR 1.36, 95% CI 1.11–1.68), and owning a house (OR 2.28, 95% CI 1.85–2.80). Factors affecting antenatal care include the woman’s literacy (OR 1.49, 95% CI 1.28–1.73), the respondent having had a job in the last year (OR 1.39, 95% CI 1.10–1.77), and owning a house (OR 2.83, 95% CI 2.27–3.53). Home delivery tends to be associated with woman’s literacy (OR 0.62, 95% CI 0.54–0.72) and marriage age of 15 and younger (OR 1.48, 95% CI 1.26–1.73). Conclusions: Interventions having equity considerations need to disrupt existing patterns of the health gradient. Successful implementation of such interventions, necessitate understanding the mechanisms that can disrupt the unequal utilization patterns and target domains of disadvantage. Knowledge of key predictors of utilization can aid in the implementation of such complex interventions.

show abstract

Section: Introductionmentioning

confidence: 99%

Towards an understanding of the multilevel factors associated with maternal health care utilization in Uttar Pradesh, India

Sridharan

Dey

Seth

et al. 2017

Global Health Action

View full text Add to dashboard Cite

show abstract

“…They point to evidence that the private sector is more responsive to patient preferences and more convenient and may be better equipped, supplied or trained . Others are more sceptical, particularly about the role of for‐profit private providers, and are concerned about the presence of unqualified providers, the financial incentives for overprovision of tests or services and the potentially impoverishing impact of out‐of‐pocket payments .…”

Section: Introductionmentioning

confidence: 99%

Family planning, antenatal and delivery care: cross‐sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low‐ and middle‐income countries

Campbell

Beňová

Macleod

et al. 2016

Tropical Med Int Health

View full text Add to dashboard Cite

Abstractobjective The objective of this study was to assess the role of the private sector in low-and middleincome countries (LMICs). We used Demographic and Health Surveys for 57 countries (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) to evaluate the private sector's share in providing three reproductive and maternal/newborn health services (family planning, antenatal and delivery care), in total and by socio-economic position.methods We used data from 865 547 women aged 15-49, representing a total of 3 billion people. We defined 'met and unmet need for services' and 'use of appropriate service types' clearly and developed explicit classifications of source and sector of provision.results Across the four regions (sub-Saharan Africa, Middle East/Europe, Asia and Latin America), unmet need ranged from 28% to 61% for family planning, 8% to 22% for ANC and 21% to 51% for delivery care. The private-sector share among users of family planning services was 37-39% across regions (overall mean: 37%; median across countries: 41%). The private-sector market share among users of ANC was 13-61% across regions (overall mean: 44%; median across countries: 15%). The private-sector share among appropriate deliveries was 9-56% across regions (overall mean: 40%; median across countries: 14%). For all three healthcare services, women in the richest wealth quintile used private services more than the poorest. Wealth gaps in met need for services were smallest for family planning and largest for delivery care.conclusions The private sector serves substantial numbers of women in LMICs, particularly the richest. To achieve universal health coverage, including adequate quality care, it is imperative to understand this sector, starting with improved data collection on healthcare provision.keywords maternal heath, family planning, antenatal care, delivery care, Demographic and Health Surveys, private sector

show abstract

“…However, several studies show a persistent and unaccounted high level of out-of-pocket expenditure (OOPE) on maternal care (antenatal, delivery and postnatal), similar to expenditure on other public hospital based services [21–23]. The high OOPE is especially catastrophic for poor households, who are often pushed into further poverty and indebtedness on account of this [24–28].…”

Section: Introductionmentioning

confidence: 99%

Out of pocket expenditure to deliver at public health facilities in India: a cross sectional analysis

et al. 2016

View full text Add to dashboard Cite

BackgroundTo expand access to safe deliveries, some developing countries have initiated demand-side financing schemes promoting institutional delivery. In the context of conditional cash incentive scheme and free maternity care in public health facilities in India, studies have highlighted high out of pocket expenditure (OOPE) of Indian families for delivery and maternity care. In this context the study assesses the components of OOPE that women incurred while accessing maternity care in public health facilities in Uttar Pradesh, India. It also assesses the determinants of OOPE and the level of maternal satisfaction while accessing care from these facilities.MethodIt is a cross-sectional analysis of 558 recently delivered women who have delivered at four public health facilities in Uttar Pradesh, India. All OOPE related information was collected through interviews using structured pre-tested questionnaires. Frequencies, Mann-Whitney test and categorical regression were used for data reduction.ResultsThe analysis showed that the median OOPE was INR 700 (US$ 11.48) which varied between INR 680 (US$ 11.15) for normal delivery and INR 970 (US$ 15.9) for complicated cases. Tips for getting services (consisting of gifts and tips for services) with a median value of INR 320 (US$ 5.25) contributed to the major share in OOPE. Women from households with income more than INR 4000 (US$ 65.57) per month, general castes, primi-gravida, complicated delivery and those not accompanied by community health workers incurred higher OOPE. The significant predictors for high OOPE were caste (General Vs. OBC, SC/ST), type of delivery (Complicated Vs. Normal), and presence of ASHA (No Vs. Yes). OOPE while accessing care for delivery was one among the least satisfactory items and 76 % women expressed their dissatisfaction.ConclusionEven though services at the public health facilities in India are supposed to be provided free of cost, it is actually not free, and the women in this study paid almost half of their mandated cash incentives to obtain delivery care.

show abstract

The Burden of Maternal Health Care Expenditure in India: Multilevel Analysis of National Data

Cited by 50 publications

References 18 publications

Towards an understanding of the multilevel factors associated with maternal health care utilization in Uttar Pradesh, India

Towards an understanding of the multilevel factors associated with maternal health care utilization in Uttar Pradesh, India

Family planning, antenatal and delivery care: cross‐sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low‐ and middle‐income countries

Out of pocket expenditure to deliver at public health facilities in India: a cross sectional analysis

Contact Info

Product

Resources

About