Contrast in utilization of maternal and child health services between Himalayan region and rest of India: Evidence from National Family Health Survey (2015\u201316)

Akif Mustafa,Chander Shekhar

doi:10.1186/s12884-021-04081-0

Akif Mustafa, Chander Shekhar

Open Access

https://doi.org/10.1186/s12884-021-04081-0

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Abstract

BackgroundMaternal and child health services, like antenatal care, skilled birth attendance and postnatal care, are crucial to improve maternal and neonatal health outcomes. Numerous studies have been conducted on the distribution of utilization of maternal and child healthcare (MCH) services in India with respect to socioeconomic and demographic characteristics. But no study has analyzed the utilization of MCH services with a focus on the topography of a given region (hilly/plain). The present study analyzes the utilization of MCH services in the hilly-Himalayan region of India in comparison to the rest of the country.MethodsData from India’s National Family Health Survey-4 (2015–16), on 190,898 women, was utilized for analysis in the present study. The association between the utilization of MCH services and the topography of the region of residence (hilly/plain) was analyzed by calculating adjusted odds ratios (AOR) with 95% confidence interval (95%CI) and predicted probabilities using a two-level random intercept logistic regression model.ResultsIt was found that the utilization of MCH services was significantly lower in the hilly regions compared to the plain regions. Women living in hilly areas (AOR: 0.42, 95%CI: 0.39–0.45) had 58% lower odds of receiving skilled birth attendance (SBA) than those living in plain areas. Similarly, the odds of receiving PNC, ANC, and full immunization were also lower in the hilly regions compared to the plain regions. The utilization of MCH services was alarmingly low in the rural-hilly regions. The odds of receiving two tetanus injections before birth were 71% lower for women in the rural-hilly areas (AOR: 0.39, 95% CI: 0.36–43) than those in the rural-plain areas. Predicted probabilities also showed that women in the hilly regions were less likely to receive MCH services compared to their counterparts in the plain regions.ConclusionExcept for the consumption of Iron Folic Acid (IFA) and the utilization of AWC services/ICDS (Integrated Child and Development Services), all other MCH services were significantly underutilized in the hilly regions compared to the plain regions. This calls for the attention of and concentrated efforts by policy makers and stakeholders, with a special focus on the rural-hilly regions. We firmly believe that the results of the present study have important policy implications.

Highlights

A major proportion of the child and maternal mortalities occur during child birth and the postnatal period, with most deaths occurring in the first 24 h of birth [1,2,3]
A rural woman living in a hilly region (AOR: 0.42, 95% confidence interval (95%confidence interval (CI)): 0.39–0.45) was 66% less likely to receive skilled birth attendance (SBA) than a rural woman living in a plain area
Women living in the hilly-urban areas (AOR: 0.84, 95%CI: 0.71–0.99) had 16% less odds of receiving SBA than those living in the plain-urban areas

Summary

Introduction

A major proportion of the child and maternal mortalities occur during child birth and the postnatal period, with most deaths occurring in the first 24 h of birth [1,2,3]. In 2017, approximately 2,95,000 women died around the world, 94% of them being from the low- and middle-income countries (LMICs), due to complications related to pregnancy and child birth [4]. WHO has stated that in the year 2017, 4.1 million infants lost their lives before their first birthday and that 808 women died daily due to complications related to pregnancy and child birth [5, 6]. The present study analyzes the utilization of MCH services in the hillyHimalayan region of India in comparison to the rest of the country

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