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Inequalities in the utilization of maternal health care in the pre- and post-National Health Mission periods in India

Published online by Cambridge University Press:  24 June 2019

Balhasan Ali ,
Preeti Dhillon Open the ORCID record for Preeti Dhillon [Opens in a new window]  and
Sanjay K. Mohanty
Balhasan Ali
Affiliation:
Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
Preeti Dhillon*
Affiliation:
Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
Sanjay K. Mohanty
Affiliation:
Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
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Abstract

Since the implementation of the National Health Mission (NHM) in India there has been a noticeable improvement in the utilization of maternal care, namely antenatal care (ANC), skilled birth attendants (SBA) and postnatal care (PNC) in the country. The increase in utilization of these services is expected to reduce inequality across geographies and population sub-groups, but little is known about the extent of inequality in maternal care use across socioeconomic groups over time. Using data from the last two rounds of National Family Health Surveys conducted in 2005–06 and 2015–16, this study examined the extent of inequality in utilization of full ANC, SBA and PNC in India and its states. Descriptive statistics were used, a concentration index was computed and decomposition analyses performed to understand the pattern and change of inequality in use of maternal care. The results suggest that the gap in maternal care utilization across socioeconomic groups has reduced over time. The concentration index for SBA showed a decline from 0.49 in 2005–06 to 0.08 by 2015–16, while that of PNC declined from 0.36 to 0.13 over the same period. The reduction in inequality in utilization of full PNC was the least. The results of the decomposition analysis revealed that urban residence, education and belonging to Scheduled Caste and Scheduled Tribes positively contributed to the inequality. Based on these findings, it is suggested that the Janani Suraksha Yojana and Janani Sishu Suraksha Karyakaram schemes be continued and strengthened for poor mothers to reduce maternal health inequality, particularly in full ANC and PNC.

Keywords

InequalityMaternal careIndia
Type
Research Article
Information
Journal of Biosocial Science , Volume 52 , Issue 2 , March 2020 , pp. 198 - 212
Copyright
© Cambridge University Press 2019 

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References

Adhikari, T, Sahu, D, Nair, S, Saha, KB, Sharma, RK and Pandey, A (2016) Factors associated with utilisation of antenatal care services among tribal women: a study of selected States. Indian Journal of Medical Research 144(1), 58–66.Google ScholarPubMed
Ahmed, S, Creanga, AA, Gillespie, DG and Tsui, AO (2010) Economic status, education and empowerment: implications for maternal health service utilisation in developing countries. PloS One 5(6), e11190.CrossRefGoogle Scholar
Alkema, L, Chou, D, Hogan, D, Zhang, S, Moller, AB, Gemmill, A et al. (2016) Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet 387(10017), 462–474.CrossRefGoogle ScholarPubMed
Balarajan, Y, Selvaraj, S and Subramanian, SV (2011) Health care and equity in India. The Lancet 377(9764), 505–515.CrossRefGoogle ScholarPubMed
Barros, AJ, Ronsmans, C, Axelson, H, Loaiza, E, Bertoldi, AD, França, GV et al. (2012) Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. The Lancet 379(9822), 1225–1233.CrossRefGoogle ScholarPubMed
Baru, R, Acharya, A, Acharya, S, Kumar, A S and Nagaraj, K (2010) Inequities in access to health services in India: caste, class and region. Economic and Political Weekly 45(38), 49–58.Google Scholar
Bhutta, ZA, Ahmed, T, Black, RE, Cousens, S, Dewey, K, Giugliani, E et al. (2008) What works? Interventions for maternal and child undernutrition and survival. The Lancet 371(9610), 417–440.CrossRefGoogle Scholar
Bhutta, ZA, Chopra, M, Axelson, H, Berman, P, Boerma, T, Bryce, J et al. (2010) Countdown to 2015-decade report (2000–10): taking stock of maternal, newborn, and child survival. The Lancet 375(9730), 2032–2044.CrossRefGoogle ScholarPubMed
Bonu, S, Bhushan, I, Rani, M and Anderson, I (2009) Incidence and correlates of ‘catastrophic’ maternal health care expenditure in India. Health Policy and Planning 24(6), 445–456.CrossRefGoogle ScholarPubMed
Cai, J, Coyte, PC and Zhao, H (2017) Decomposing the causes of socioeconomic-related health inequality among urban and rural populations in China: a new decomposition approach. International Journal for Equity in Health 16(1), 128.CrossRefGoogle Scholar
Campbell, OM, Graham, WJ and Lancet Maternal Survival Series Steering Group (2006) Strategies for reducing maternal mortality: getting on with what works. The Lancet 368(9543), 1284–1299.CrossRefGoogle Scholar
Chopra, M, Lawn, JE, Sanders, D, Barron, P, Karim, SSA, Bradshaw, D et al. (2009) Achieving the health Millennium Development Goals for South Africa: challenges and priorities. The Lancet 374(9694), 1023–1031.CrossRefGoogle ScholarPubMed
Dehury, RK (2016) Maternal health services in the tribal community of Balasore district, Odisha: challenges and implications. BMJ Global Health 1, A3–A4.Google Scholar
Deshpande, A (2000) Does caste still define disparity? A look at inequality in Kerala, India. American Economic Review 90(2), 322–325.Google Scholar
Feng, XL, Guo, S, Hipgrave, D, Zhu, J, Zhang, L and Song, L et al. (2011) China’s facility-based birth strategy and neonatal mortality: a population-based epidemiological study. The Lancet 378(9801), 1493–1500.CrossRefGoogle ScholarPubMed
Gao, Y, Zhou, H, Singh, NS, Powell-Jackson, T, Nash, S, Yang, M et al. (2017) Progress and challenges in maternal health in western China: a countdown to 2015 national case study. The Lancet Global Health 5(5), e523–e536.CrossRefGoogle ScholarPubMed
Ghosh, A (2015) Inequality in maternal health-care services and safe delivery in eastern India. WHO South-East Asia Journal of Public Health 4(1), 54–61CrossRefGoogle ScholarPubMed
Goland, E, Hoa, DTP and Målqvist, M (2012) Inequity in maternal health care utilisation in Vietnam. International Journal for Equity in Health 11(1), 24.CrossRefGoogle Scholar
Goldie, SJ, Sweet, S, Carvalho, N, Natchu, UCM and Hu, D (2010) Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis. PLoS Medicine 7(4), e1000264.CrossRefGoogle ScholarPubMed
Hajizadeh, M, Alam, N and Nandi, A (2014) Social inequalities in the utilisation of maternal care in Bangladesh: have they widened or narrowed in recent years? International Journal for Equity in Health 13(1), 120.CrossRefGoogle ScholarPubMed
Hosseinpoor, AR, Doorslaer, EV, Speybroeck, N, Naghavi, M, Mohammad, K, Majdzadeh, R et al. (2006) Decomposing socioeconomic inequality in infant mortality in Iran. International Journal of Epidemiology 35(5), 1211–1219.CrossRefGoogle ScholarPubMed
IIPS and ICF (2017) National Family Health Survey (NFHS-4), 2015–16. International Institute for Population Sciences, Mumbai, India.Google Scholar
IIPS and Macro International (2007) National Family Health Survey (NFHS-3), 2005–06. International Institute for Population Sciences, Mumbai, India.Google Scholar
Jat, TR, Ng, N and Sebastian, MS (2011) Factors affecting the use of maternal health services in Madhya Pradesh state of India: a multilevel analysis. International Journal for Equity in Health 10(1), 59.CrossRefGoogle Scholar
Kamal, N, Curtis, S, Hasan, MS and Jamil, K (2016) Trends in equity in use of maternal health services in urban and rural Bangladesh. International Journal for Equity in Health 15(1), 27.CrossRefGoogle Scholar
Kumar, A and Singh, A (2015) Explaining the gap in the use of maternal healthcare services between social groups in India. Journal of Public Health 38(4), 771–781.Google Scholar
Ladusingh, L and Holendro Singh, C (2007) Rich–poor gap in maternal care: the case of northeast India. Asian Population Studies 3(1), 79–94.CrossRefGoogle Scholar
Leone, T, Cetorelli, V, Neal, S and Matthews, Z (2016) Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis. BMJ Open 6(1), e009692.CrossRefGoogle ScholarPubMed
Li, C, Zeng, L, Dibley, MJ, Wang, D, Pei, L and Yan, H (2015) Evaluation of socio-economic inequalities in the use of maternal health services in rural western China. Public Health 129(9), 1251–1257.CrossRefGoogle ScholarPubMed
Lim, SS, Dandona, L, Hoisington, JA, James, SL, Hogan, MC and Gakidou, E (2010) India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. The Lancet 375(9730), 2009–2023.CrossRefGoogle ScholarPubMed
Liu, X, Gao, W and Yan, H (2014) Measuring and decomposing the inequality of maternal health services utilisation in Western Rural China. BMC Health Services Research 14(1), 102.CrossRefGoogle Scholar
Lozano, R, Wang, H, Foreman, KJ, Rajaratnam, JK, Naghavi, M, Marcus, JR et al. (2011) Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. The Lancet 378(9797), 1139–1165.CrossRefGoogle ScholarPubMed
Magadi, MA, Zulu, EM and Brockerhoff, M (2003) The inequality of maternal health care in urban sub-Saharan Africa in the 1990s. Population Studies 57(3), 347–366.CrossRefGoogle ScholarPubMed
Makate, M and Makate, C (2017) The evolution of socioeconomic status-related inequalities in maternal health care utilisation: evidence from Zimbabwe, 1994–2011. Global Health Research and Policy 2(1), 1.CrossRefGoogle Scholar
Marmot, M, Friel, S, Bell, R, Houweling, TA, Taylor, S and Commission on Social Determinants of Health (2008) Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet 372(9650), 1661–1669.CrossRefGoogle Scholar
Marten, R, McIntyre, D, Travassos, C, Shishkin, S, Longde, W, Reddy, S and Vega, J (2014) An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). The Lancet 384(9960), 2164–2171.CrossRefGoogle Scholar
Memirie, ST, Verguet, S, Norheim, OF, Levin, C and Johansson, KA (2016) Inequalities in utilisation of maternal and child health services in Ethiopia: the role of primary health care. BMC Health Services Research 16(1), 51.CrossRefGoogle Scholar
Mezmur, M, Navaneetham, K, Letamo, G and Bariagaber, H (2017) Socioeconomic inequalities in the uptake of maternal healthcare services in Ethiopia. BMC Health Services Research 17(1), 367.CrossRefGoogle ScholarPubMed
Mohanty, SK and Kastor, A (2017) Out-of-pocket expenditure and catastrophic health spending on maternal care in public and private health centres in India: a comparative study of pre and post national health mission period. Health Economics Review 7(1), 31.CrossRefGoogle ScholarPubMed
Mohanty, SK and Pathak, PK (2009) Rich–poor gap in utilisation of reproductive and child health services in India, 1992–2005. Journal of Biosocial Science 41(3), 381–398.CrossRefGoogle Scholar
Nair, H and Panda, R (2011) Quality of maternal healthcare in India: has the National Rural Health Mission made a difference? Journal of Global Health 1(1), 79.Google ScholarPubMed
Norheim, OF, Jha, P, Admasu, K, Godal, T, Hum, R J et al. (2015) Avoiding 40% of the premature deaths in each country, 2010–30: review of national mortality trends to help quantify the UN Sustainable Development Goal for health. The Lancet 385(9964), 239–252.CrossRefGoogle Scholar
O’Donnell, O, Doorslaer, EV, Wagstaff, A and Lindelow, M. (2007) Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and their Implementation. World Bank, Washington, DC.CrossRefGoogle Scholar
Pallikadavath, S, Foss, M and Stones, RW (2004) Antenatal care: provision and inequality in rural north India. Social Science & Medicine 59(6), 1147–1158.CrossRefGoogle ScholarPubMed
Pathak, PK, Singh, A and Subramanian, SV (2010) Economic inequalities in maternal health care: prenatal care and skilled birth attendance in India, 1992–2006. PloS One 5(10), e13593.CrossRefGoogle Scholar
Prusty, RK, Gouda, J and Pradhan, MR (2015) Inequality in the utilisation of maternal healthcare services in Odisha, India. International Journal of Population Research, article ID 531485.Google Scholar
Rai, RK, Singh, PK and Singh, L (2012) Utilisation of maternal health care services among married adolescent women: insights from the Nigeria Demographic and Health Survey, 2008. Women’s Health Issues 22(4), e407–e414.CrossRefGoogle Scholar
Randive, B, Diwan, V and Costa, AD (2013) India’s Conditional Cash Transfer Programme (the JSY) to promote institutional birth: is there an association between institutional birth proportion and maternal mortality? PloS One 8(6), e67452.CrossRefGoogle ScholarPubMed
RGI (2018) Special Bulletin on Maternal Mortality in India 2014–16. Sample Registration System (SRS), Office of Registrar General, India. URL: http://www.censusindia.gov.in/2011-common/Sample_Registration_System.htmlGoogle Scholar
Sanneving, L, Trygg, N, Saxena, D, Mavalankar, D and Thomsen, S (2013) Inequity in India: the case of maternal and reproductive health. Global Health Action 6(1), 19145.CrossRefGoogle ScholarPubMed
Saxena, D, Vangani, R, Mavalankar, D and Thomsen, S (2013) Inequity in maternal health care service utilisation in Gujarat: analyses of district-level health survey data. Global Health Action 6(1), 19652.CrossRefGoogle Scholar
Say, L and Raine, R (2007). A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bulletin of the World Health Organization 85, 812–819.CrossRefGoogle Scholar
Singh, PK, Rai, RK, Alagarajan, M and Singh, L (2012). Determinants of maternity care services utilisation among married adolescents in rural India. PloS One 7(2), e31666.CrossRefGoogle Scholar
Sudha, S and Morrison, S (2011) Marital violence and women’s reproductive health care in Uttar Pradesh, India. Women’s Health Issues 21(3), 214–221.CrossRefGoogle ScholarPubMed
Wagstaff, A, Doorslaer, EV and Watanabe, N (2003) On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. Journal of Econometrics 112(1), 207–223.CrossRefGoogle Scholar
WHO (2016a) World Health Statistics 2016: Monitoring Health for the SDGS Sustainable Development Goals. World Health Organization, Geneva. URL: https://www.who.int/gho/publications/world_health_statistics/2016/en/Google Scholar
WHO (2016b) WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. World Health Organization, Geneva. URL: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/Google Scholar
Yaya, S, Bishwajit, G and Shah, V (2016) Wealth, education and urban–rural inequality and maternal healthcare service usage in Malawi. BMJ Global Health 1(2), e000085.CrossRefGoogle ScholarPubMed