Abstract
Numerous studies have examined the empirical evidence concerning the influence of demographic and socio-economic factors influencing child immunization, but no documentation is available which shows the actual impact of antenatal care (ANC) visits on subsequent child immunization. Therefore, this paper aims to examine the net impact of ANC visits on subsequent utilization of child immunization after removing the presence of selection bias. Nationwide data from India’s latest National Family Health Survey conducted during 2005–06 is used for the present study. The analysis has been carried out in the two separate models, in the first model 1–2 ANC visit and in the second model three or more ANC visits has been compared with no visit. We have used propensity score matching method with a counterfactual model that assesses the actual ANC visits effect on treated (ANC visits) and untreated groups (no ANC visit), and have employed Mantel-Haenszel bounds to examine whether result would be free from hidden bias or not. Using matched sample analysis result shows that child immunization among the groups of women who have completed 1–2 ANC visits and those who had more than two visits was about 13 percent and 19 percent respectively, higher than the group of women who have not made any ANC visit. Findings of nearest neighbor matching with replacement method, which completely eliminated the bias, indicate that selection bias present in data set leads to overestimates the positive effects of ANC visits on child immunization. Result based on Mantel-Haenszel bounds method suggest that if around 19 percent bias would be involved in the result then also we could observe the true positive effect of 1–2 ANC visits on child immunization. This also indicates that antenatal clinics are the conventional platforms for educating pregnant women on the benefits of child immunization.
Highlights
Despite decades of progress in improving the availability of child vaccination services, many countries including India, still experience an unacceptably high level of infant and child mortality
We investigate to what extent the net difference observed in the outcome between treated and untreated groups of women could be attributed to antenatal care (ANC) visits, given that all possible covariates are matched and use sensitivity analyses to investigate the robustness of the findings
It can be noted from the table that compared to their matching counterparts, mothers who did not make any ANC visits were significantly less likely to reside in urban areas, were from eastern or central regions, were less wealthy and less educated
Summary
Despite decades of progress in improving the availability of child vaccination services, many countries including India, still experience an unacceptably high level of infant and child mortality. It is estimated that around 7.6 million children die each year before their 5th birthday worldwide [1], with India being the country with the highest number of childhood deaths [2]. Immunization currently averts an estimated three million deaths every year in all age groups from diphtheria, tetanus, pertussis (whooping cough), and measles [3]. It is evident that in India a large proportion of infant deaths could be prevented if children received complete immunization. The Government of India has adopted the WHO vaccination schedule for free immunization of 0–6 year old children. In spite of the ‘‘extensive free’’ immunization campaigns, children from lower socio-economic strata, belonging to Muslim communities and residents of rural areas do not follow the established immunization schedule [6,7].
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