Abstract
Literature asserts that prenatal care is an imperative factor for subsequent health care utilization. However, in the Indian settings presence of selection bias while determining the impact of ANC visits on institutional delivery has been overlooked by the researchers. Therefore this paper aims to examine the net impact of ANC visits on subsequent utilization of institutional delivery after removing the presence of selection bias using recent round of National Family Health survey data. The analysis has been carried out in two separate models, in the first model 1-2 ANC visits been compared with no visit and in the second model three or more antenatal care visits with no visit. The propensity score matching analysis used in this study sheds new light into this line of research which provides an effective strategy for controlling the confounding influence of institutional delivery. Employing the propensity score matching estimation approach we found women who made 1-2 ANC visits had 6.6 percent higher chance to deliver in an institution compared to women who made no visit. In addition, if a woman visited health centre three or more than three times, her chances were 31 percent higher to deliver in an institution. Result based on sensitivity analysis suggests that selection bias on unobserved covariates would have to be around 40 percent to alter the impact of 1-2 ANC visits. Findings suggest that interventions which plan to increase institutional delivery should target pregnant women who come for ANC checkups at institution first time, and health workers should encourage women to return to the health centre for more numbers of visits, as our results indicate that three or more ANC visits significantly change the women’s attitudes towards institutional delivery.
Highlights
Despite an increase in budget collocation for health during the past decade, India is unlikely to reach the health related 2015 Millennium Development Goals (MDG) (MDG 2010)
It can be noted from the table that compared to their matching counterparts, mothers who did not make any antenatal care (ANC) visit were having significantly less chance to reside in urban areas and they mainly belong to the eastern region followed by the central region, come from the poorest and poorer households and were mainly less educated
Focusing on leverage of frequency of contact with the health systems/workers, we examined the impact of frequency of antenatal care visits on subsequent institutional delivery
Summary
Despite an increase in budget collocation for health during the past decade, India is unlikely to reach the health related 2015 Millennium Development Goals (MDG) (MDG 2010). The pace of decline is considerably slower than what would be required to meet India’s MDG target of reducing the maternal mortality ratio (MMR) 109 per 100,000 live births and the infant mortality rate (IMR) to 27 per 1000 live births. As a result of the continuing efforts made by the Government of India through various programs and endeavors of other national, international and voluntary organizations, considerable progress has been made in attaining the MDG goals. One way could be to improve maternal and neonatal health by promoting institutional delivery [1,2]. The indicators of health care (institutional delivery) and health outcomes (maternal mortality ratio and infant mortality rate) substantiate a similar association in the case of India as well (Figures 1(a) and (b)
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