Social Inequality and Institutional Deliveries (original) (raw)
Related papers
2022
The article is aimed to assess trends in wealth-related inequalities in coverage of reproductive, maternal, neonatal and child health (RMNCH) interventions using delivery channels framework in Indian context, at national level as well as at state level-Tamil Nadu (TN) and Chhattisgarh (CG)-a better off and poorer state, respectively. We used National Family Health Survey-3rd (2005-2006) and 4th (2015-2016) to study the trends and differentials of inequalities in the RMNCH coverage. We have used two summary indices-absolute inequalities using the slope index of inequality (SII) and relative inequalities using the concentration index (CIX). Culturally driven interventions had pro-poor inequalities in TN, CG and in India, but the coverage has improved significantly for the women from wealthier households recently. Environmental interventions were highly inequal in distribution, particularly for the 'use of clean fuels'. Inequalities in the coverage of health facilities-based interventions has reduced in TN, CG and overall India, but more so in TN. The inequalities in coverage of community-based interventions have reduced over the period of ten years in TN, CG as well as at national level. Adopting RMNCH delivery channel framework could be useful for assessing and monitoring the progress of public health programmes. Policy makers can gain insights from the success of coverage of various interventions and determine specific implementation strategies to reduce inequalities in the coverage and its effectiveness.
Background The use of maternal health care is limited in India despite several programmatic efforts for its improvement since the late 1980's. The use of maternal health care is typically patterned on socioeconomic and cultural contours. However, there is no clear perspective about how socioeconomic differences over time have contributed towards the use of maternal health care in India. Methodology/Principal Findings Using data from three rounds of National Family Health Survey (NFHS) conducted during 1992–2006, we analyse the trends and patterns in utilization of prenatal care (PNC) in first trimester with four or more antenatal care visits and skilled birth attendance (SBA) among poor and nonpoor mothers, disaggregated by area of residence in India and three contrasting provinces, namely, Uttar Pradesh, Maharashtra and Tamil Nadu. In addition, we investigate the relative contribution of public and private health facilities in meeting the demand for SBA, especially among poor mothers. We also examine the role of salient socioeconomic, demographic and cultural factors in influencing aforementioned outcomes. Bivariate analyses, concentration curve and concentration index, logistic regression and multinomial logistic regression models are used to understand the trends, patterns and predictors of the two outcome variables. Results indicate sluggish progress in utilization of PNC and SBA in India and selected provinces during 1992–2006. Enormous inequalities in utilization of PNC and SBA were observed largely to the disadvantage of the poor. Multivariate analysis suggests growing inequalities in utilization of the two outcomes across different economic groups. Conclusions The use of PNC and SBA remains disproportionately lower among poor mothers in India irrespective of area of residence and province. Despite several governmental efforts to increase access and coverage of delivery services to poor, it is clear that the poor (a) do not use SBA and (b) even if they had SBA, they were more likely to use the private providers.
Pathways of economic inequalities in maternal and child health in urban India
PLOS One
Background/Objective: Children and women comprise vulnerable populations in terms of health and are gravely affected by the impact of economic inequalities through multi-dimensional channels. Urban areas are believed to have better socioeconomic and maternal and child health indicators than rural areas. This perception leads to the implementation of health policies ignorant of intra-urban health inequalities. Therefore, the objective of this study is to explain the pathways of economic inequalities in maternal and child health indicators among the urban population of India. Methods: Using data from the third wave of the National Family Health Survey (NFHS, 2005–06), this study calculated relative contribution of socioeconomic factors to inequalities in key maternal and child health indicators such as antenatal check-ups (ANCs), institutional deliveries, proportion of children with complete immunization, proportion of underweight children, and Infant Mortality Rate (IMR). Along with regular CI estimates, this study applied widely used regression-based Inequality Decomposition model proposed by Wagstaff and colleagues. Results: The CI estimates show considerable economic inequalities in women with less than 3 ANCs (CI = 20.3501), institutional delivery (CI = 20.3214), children without fully immunization (CI = 20.18340), underweight children (CI = 20.19420), and infant deaths (CI = 20.15596). Results of the decomposition model reveal that illiteracy among women and her partner, poor economic status, and mass media exposure are the critical factors contributing to economic inequalities in maternal and child health indicators. The residuals in all the decomposition models are very less; this implies that the above mentioned factors explained maximum inequalities in maternal and child health of urban population in India. Conclusion: Findings suggest that illiteracy among women and her partner, poor economic status, and mass media exposure are the critical pathways through which economic factors operate on inequalities in maternal and child health outcomes in urban India.
BMC Public Health, 2012
Background While India has made significant progress in reducing maternal mortality, attaining further declines will require increased skilled birth attendance and institutional delivery among marginalized and difficult to reach populations. Methods A population-based survey was carried out among 16 randomly selected rural villages in rural Mysore District in Karnataka, India between August and September 2008. All households in selected villages were enumerated and women with children 6 years of age or younger underwent an interviewer-administered questionnaire on antenatal care and institutional delivery. Results Institutional deliveries in rural areas of Mysore District increased from 51% to 70% between 2002 and 2008. While increasing numbers of women were accessing antenatal care and delivering in hospitals, large disparities were found in uptake of these services among different castes. Mothers belonging to general castes were almost twice as likely to have an institutional birt...
District level inequality in reproductive, maternal, neonatal and child health coverage in India
BMC Public Health, 2020
Background: As India already missed maternal and child health related millennium development goals, the maternal and child health outcomes are a matter of concern to achieve sustainable development goals (SDGs). This study is focused to assess the gap in coverage and inequality of various reproductive, maternal, neonatal and child health (RMNCH) indicators in 640 districts of India, using data from most recent round of National Family Health Survey. Methods: A composite index named Coverage Gap Index (CGI) was calculated, as the weighted average of eight preventive maternal and child care interventions at different administrative levels. Bivariate and spatial analysis were used to understand the geographical diversity and spatial clustering in districts of India. A socioeconomic development index (SDI) was also derived and used to assess the interlinkages between CGI and development. The ratio method was used to assess the socioeconomic inequality in CGI and its component at the national level. Results: The average national CGI was 26.23% with the lowest in Kerala (10.48%) and highest in Nagaland (55.07%). Almost half of the Indian districts had CGI above the national average and mainly concentrated in high focus states and northeastern part. From the geospatial analysis of CGI, 122 districts formed hotspots and 164 districts were in cold spot. The poorest households had 2.5 times higher CGI in comparison to the richest households and rural households have 1.5 times higher CGI as compared to urban households. Conclusion: Evidence from the study suggests that many districts in India are lagging in terms of CGI and prioritize to achieve the desired level of maternal and child health outcomes. Efforts are needed to reduce the CGI among the poorest and rural resident which may curtail the inequality.
India contributes significantly to the global burden of maternal deaths. More than 20% of all maternal deaths occur in India. To tackle this and especially to promote institutional deliveries, the government of India has introduced a conditional cash assistance programme called the Janani Suraksha Yojana (JSY). Under this programme, poor women who have had three antenatal check ups and who deliver in a health facility would get money soon after delivery to take care of their direct and indirect costs. We interviewed staff and women who had recently delivered from four Indian states, to determine how the JSY is functioning in the field and whether it is meeting its original objective of increasing institutional deliveries. While there is some evidence to suggest that there has been an increase in institutional deliveries, we were able neither to quantify it nor attribute it to the JSY. This is because of the paucity of good quality data at the state and district levels. Both the staff as well as the pregnant women were happy with the scheme and felt that it met an important need. However, there were some important gaps in the implementation of the scheme. We found that some of the poor women were not aware of the programme; that the documentation processes had become very cumbersome and that there was a considerable delay in the women getting the cash benefit. Some women also mentioned that they received only partial amounts - the rest being pocketed by the health staff. The most significant issue was that the scheme has been changed to permit the cash benefit to go to all women who deliver, irrespective of the site of delivery. This has resulted in this scheme actually promoting home deliveries, a perversion of the original objective. Keywords: India; maternal mortality ratio; institutional deliveries; conditional cash transfers; Janani Suraksha Yojana.
Unpacking the Myths: Inequities and maternal mortality in South Asia
Development, 2005
Imrana Qadeer examines whether the Millennium Development Goals (MDG) are different from past approaches to maternal mortality in South Asia and critically assesses how they address the underlying inequities that determine reproductive health policies. She argues that policies to reduce maternal mortality can work, but that these strategies require a long-term perspective that is based on holistic development of the people and not just a select section given that maternal mortality is largely the outcome of poor general health and socioeconomic constraints.
Socioeconomic and regional disparities in safe delivery in India (1990-2006)
International Journal of Community Medicine and Public Health, 2016
Background: Giving birth to a child is not only a strain for the body, but it also puts the woman's health at risk. Globally, nearly 300,000 thousand women die each year as a result of pregnancy related complications. India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010). Addressing the maternity care needs of women may have considerable ramifications for achieving the Millennium Development Goal (MDG)-5. The proportion of births attended by skilled health personnel (safe delivery) is one of the main indicators used to monitor progress in reaching MDG 5. The main objective of this study was to the traces the changes in utilization patterns and determinants of safe delivery care services by women in India, during last one and half decade, 1990-2006. Methods: Data from three rounds of the Demographic and Health Survey (DHS), known as the National Family Health Survey (NFHS) in India were analyzed. Bivariate and multivariate-pooled logistic regression model were applied to assessing the trends and determinants of safe delivery care services utilization, over one and half decade, 1990-2006 and also fit models stratified by survey periods and with interactions among key socioeconomic predictors to show the extent of disparity in the utilization of safe delivery care services among women belonging to different socioeconomic strata. Results: The results from analysis indicate that the coverage of safe delivery has increased from 34 percent to 50 percent during the last one and half decade. Overall, it can be said that, there was an improvement in the level of safe deliveries over the period of time. This improvement was somewhere very marginal, but somewhere very pronounced too. The results shows those women's education, husband's education, religion, caste, mass media exposure, birth order and interval, wealth quintile and region of residence were found to be statistically significant determinants in the utilization of safe delivery care services. Women from the Southern region utilizing the highest safe delivery care services compared to other regions. Conclusions: The region specific inequalities, which were greater than the socioeconomic inequalities, may be reduced by expanding outreach health programs to bring services closer to the disadvantaged. Promoting the use of family planning, female education, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of safe delivery care services among women. Maternity programmes should be designed keeping in mind the socioeconomic and geographically context, especially women who belongs to EAG states, India.
BMC Public Health
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.