Inequalities in the utilisation of maternal health Care in Rural India: Evidences from National Family Health Survey III & IV

Balhasan Ali,Shekhar Chauhan

doi:10.1186/s12889-020-08480-4

Balhasan Ali, Shekhar Chauhan

Open Access

https://doi.org/10.1186/s12889-020-08480-4

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Abstract

BackgroundSince the implementation of National Rural Health Mission (NRHM) in 2005, Maternal Mortality Ratio has significantly declined in India through a noticeable improvement in maternal health care services. However, India did not succeed to achieve the target of millennium development goal to reduced maternal mortality ratio by 2015. Also, there is substantial inequality exist at the regional, geographic, economic, and social level, and various socioeconomic factors contribute to the significantly large share in inequality in utilisation of maternal health care in India.MethodsUsing data from the National Family Health Survey (2005 and 2015), this study examined the degree of inequality exist in maternal health care namely full antenatal care (full ANC), skilled attendants at birth (SBA), and postnatal care (PNC) in rural India. Descriptive statistics, concentration index (CI), and Wagstaff decomposition method have been performed to understand the pattern of maternal health care utilisation, and to explain the extent of inequality in maternal health care utilisation.ResultsThe study revealed that a substantial gap across socioeconomic groups exist in utilisation of maternal health care has significantly reduced in rural India during 2005–16. The results found a noticeable improvement in maternal health care utilisation, especially in utilisation of skilled attendants at birth (SBA). During this decade, the concentration index for SBA showed a significant decline from 0.28 in 2005–06 to 0.09 in 2015–16, while that of full ANC declined from 0.47 to 0.32 over the same period, and reduction of inequality in full ANC was least. Further, the results of decomposition analysis suggested that secondary and higher education, mass media exposure, and scheduled tribe contributed a significant share to the inequality.ConclusionThe exposure to mass media is the most significant contributor to inequality, and hence, there is a need for broad dissemination of awareness regarding maternal health care schemes in rural parts of country. Based on findings of study, it is suggested that health scheme related to maternal and child health care under NRHM be continued and focused for lower socioeconomic groups and marginalized mothers to reduce maternal health services inequality, particularly in the component of full ANC.

Highlights

Since the implementation of National Rural Health Mission (NRHM) in 2005, Maternal Mortality Ratio has significantly declined in India through a noticeable improvement in maternal health care services
Based on findings of study, it is suggested that health scheme related to maternal and child health care under NRHM be continued and focused for lower socioeconomic groups and marginalized mothers to reduce maternal health services inequality, in the component of full antenatal care (ANC)
The utilization of all the three determinants of maternal health-care namely; full antenatal care, skill attendants at birth, and postnatal care has increased among the women from all the socioeconomic groups over the two periods from 2005 to 06 to 2015–16, significant differences still persist by background characteristics

Summary

Introduction

Since the implementation of National Rural Health Mission (NRHM) in 2005, Maternal Mortality Ratio has significantly declined in India through a noticeable improvement in maternal health care services. There is substantial inequality exist at the regional, geographic, economic, and social level, and various socioeconomic factors contribute to the significantly large share in inequality in utilisation of maternal health care in India. India contributes to about 27 million births per year in the world and accounts for 20% of global maternal deaths [3]. In India, nearly 26% [9] of the population constitute women of reproductive age (15–49 years) These women are exposed to the risk of pregnancy and childbearing, and under existing socioeconomic differences [10] and the inequality in medical health facilities, these women are at a higher risk of morbidity and mortality resulting from the pregnancy-related issues.

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