Inequalities in utilisation of maternal health services in urban India: Evidences from national family health survey-4

Abstract

India has achieved noticeable decline in maternal mortality ratio through the implementation of National Health Mission programme across the country. However, India lags behind to achieve the target of millennium development goal (MDG5) to reduced maternal mortality ratio and improve universal reproductive health by 2015.The significant improvement in maternal health care utilisation is expected to reduce geographical, regional, socio-economic inequality across the subgroups of population, but little is known about the degree of inequality in maternal health in urban subgroups. Using data from National Family Health Survey conducted in 2015–16, this study quantifies the extent of inequality in utilisation of maternal health care in urban India. The study found substantial disparities in utilisation of maternal health care among poor and non-poor. The findings show significant gap in maternal health care utilisation among poor and non-poor with pronounced inequality in full antenatal care followed by post-natal care and skilled attendants at birth. Further, concentration index (CI) estimates reveal that maternal health services were concentrated among more affluent women and the CI for SBA was 0.042, and, for PNC, CI was 0.063, while CI was 0.169 for Full ANC at national level. The decomposition analysis reveals that higher education, Scheduled Caste and exposure to mass media positively contributed to the inequality and observed a huge poor and non-poor disparities. It is suggested that maternal health programme especially Janani Suraksha Yojana should be continued and effectively implement to increase the uptake of full ANC component and reduce maternal mortality ratio in India.