Geographical divide led inequality in accessing maternal healthcare services between hills and valley regions of Manipur state, India

Abstract

Geographically, Manipur is composed of two sets of landmasses known as the valley and the hills districts. As compared to the valley districts, the hilly district is largely remained undeveloped and lack basic infrastructure and services like healthcare facilities, educational institutions, public distribution system, transportation, etc. Little is known about the differentials in the utilization of maternal healthcare services between the hills and the valley of Manipur state of India. The paper tries to understand the inequalities in accessing maternal healthcare services between the hills and valleys region. Logistic regression and concentration index was adopted to assess the utilization of maternal healthcare services. Results indicate low utilization of maternal healthcare services in the hilly region, with only 19%, 22%, and 21% have access to 4+ ANC visit, institutional delivery, and PNC visits respectively. The odds of utilizing 4+ ANC visits [Odds Ratio (OR): 0.47, Confidence Interval (C.I):0.26–0.82], Institutional delivery [OR: 0.42, C.I:0.28–0.62], and PNC visits [OR: 0.42, C.I:0.28–0.60] were less likely in the hilly region as compared to the valley region. Valley region indicates low inequality in accessing maternal healthcare services, however high inequality in accessing to institutional delivery and PNC visits was observed in the hilly region. Inequality is significantly higher in hilly areas (CIANC:0.276; CIinst.delivery:0.277; CIPNC: 0.206) than in valley regions (CIANC:0.070; CIinst.delivery 0.088; CIPNC: 0.081). Further, mother education, household wealth, and exposure to television are the main contributor to inequality. Better educational opportunities and economic activities may improve the utilization of maternal health services.