Abstract
ObjectiveThe implemented multiple-strategy community intervention National Rural Health Mission (NRHM) between 2005 and 2012 aimed to reduce maternal and child health (MCH) inequalities across geographical, socioeconomic and gender categories in India. The objective of this study is to quantify the extent of reduction in these inequalities pre- and post-NRHM in Haryana, North India.MethodsData of district-level household surveys (DLHS) held before (2002–04), during (2007–08), and after (2012–13) the implementation of NRHM has been used. Geographical, socioeconomic and gender inequalities in maternal and child health were assessed by estimating the absolute differences in MCH indicators between urban and rural areas, between the most advantaged and least advantaged socioeconomic groups and between male and female children. Logistic regression analyses were done to observe significant differences in these inequalities between 2005 and 2012.ResultsThere were significant improvements in all MCH indicators (p<0.05). The geographical and socioeconomic differences between urban and rural areas, and between rich and poor were significantly (p<0.05) reduced for pregnant women who had an institutional delivery (geographical difference declining from 22% to 7.6%; socioeconomic from 48.2% to 13%), post-natal care within 2 weeks of delivery (2.8% to 1.5%; 30.3% to 7%); and for children with full vaccination (10% to 3.5%, 48.3% to 14%) and who received oral rehydration solution (ORS) for diarrhea (11% to -2.2%; 41% to 5%). Inequalities between male and female children were significantly (p<0.05) reversed for full immunization (5.7% to -0.6%) and BCG immunization (1.9 to -0.9 points), and a significant (p<0.05) decrease was observed for oral polio vaccine (4.0% to 0%) and measles vaccine (4.2% to 0.1%).ConclusionsThe implemented multiple-strategy community intervention National Rural Health Mission (NRHM) between 2005 and 2012 might have resulted in significant reductions in geographical, socioeconomic and gender inequalities in MCH in Haryana, as causal relationships cannot be established with descriptive research.
Highlights
Maternal and child health (MCH) inequalities across socioeconomic, geographical and gender gradient is a public health concern worldwide [1,2]
Effectiveness of Multiple-Strategy Community Intervention in Reducing Inequalities, post-natal care within 2 weeks of delivery (2.8% to 1.5%; 30.3% to 7%); and for children with full vaccination (10% to 3.5%, 48.3% to 14%) and who received oral rehydration solution (ORS) for diarrhea (11% to -2.2%; 41% to 5%)
Inequalities between male and female children were significantly (p
Summary
Maternal and child health (MCH) inequalities across socioeconomic, geographical and gender gradient is a public health concern worldwide [1,2]. This gap is much more widened in the low and middle-income group countries because of unequal distribution of resources and health facilities. There is geographical inequality in MCH outcomes, like IMR is higher in rural (44 per thousand live births) as compared to urban areas (27 per thousand live births) [6]. Large geographical and socioeconomic inequalities in MCH status and access to MCH services continue to persist in India and have even widened across states, between rural and urban areas, and within communities [7]. There are MCH interventions available to improve MCH outcomes and reduce inequalities, because of the issues at the level of implementation of these interventions that influence the accessibility and availability of health services especially to the most needy, these inequalities are not reduced. [8,9,10]
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