Abstract
BackgroundAs 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.MethodsA 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 socio-economic development index (SDI) was also derived and used to assess the interlinkages between CGI and development. The ratio method was used to assess the socio-economic inequality in CGI and its component at the national level.ResultsThe 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 north-eastern 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.ConclusionEvidence 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.
Highlights
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)
Data We used the data from the fourth round of the National Family Health Survey (NFHS-4), the most recent largescale multistage survey conducted in India in the year 2015–16
Among the various RMNCH indicators, the highest coverage had been found for Bacillus Calmette Guerin (BCG) (91.9%) followed by Skilled birth attendant (SBA) (81.4%) and least coverage for the Antenatal Care coverage (ANC) (51.2%)
Summary
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). Despite the continued global effort to improve maternal and child health in last 25 years through Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), the progress on utilization of maternal and child health services (MCH) and reduction of maternal and child mortality is not distributed among and within countries [1, 2]. The fourth goal of MDGs (MDG-4) was set to reduce two-third of under-five mortality rate, whereas the fifth goal (MDG-5) had focused on improving maternal health by cutting 75% of. In the last two decades, a substantial improvement in reducing maternal and neonatal mortality was observed in India, with accelerated progress of essential health interventions [9]. The disadvantaged population subgroups (i.e., the poorest, the least educated and those residing in rural areas) had lower health care access and coverage, and worse health outcomes [14, 15]
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