Inequalities In Use Research Articles

Measuring and decomposing socioeconomic-related inequality in the use of oral health services among Chinese adults.

This study aimed to measure socioeconomic-related inequality and horizontal inequity in the use of oral health services and decompose this inequality among adults of different age groups in China. In total, 10973 adults (3669 aged 35-44years, 3767 aged 55-64years and 3537 aged 65-74years) who participated in the 4th National Oral Health Survey (2015-2016) in China were included. Concentration curves and the Erreygers-corrected concentration index (EI) were employed to measure socioeconomic-related inequality in the use of oral health services. Then, inequity in this utilization was measured by the horizontal inequity index (HI). Furthermore, decomposition analyses were conducted for the three groups to explain the contributions of income level, need factors (ie self-assessed oral health and evaluated oral health status), other factors (ie sex, residential location, educational attainment level and type of basic insurance) and a residual term to overall inequality in oral health service utilization. The significant positive EI and HI values indicated that pro-rich inequality and inequity in oral health service utilization exist among Chinese adults. Income and type of basic medical insurance contributed the most to socioeconomic-related inequality in the use of oral health services among adults aged 55-64 and 65-74years. However, the main driving factors of socioeconomic inequality among adults aged 35-44years in dental care use included income, educational achievement, type of basic medical insurance and residential location. The need variables accounted for a very small proportion of overall socioeconomic-related inequality in oral health service use in all three groups. Oral healthcare service utilization was disproportionately concentrated among better-off Chinese adults. The primary determinants of inequality in dental care use in different age groups provide information for policymakers to create more targeted policies to achieve equity in the oral healthcare system in China.

Mujeres y usos de los espacios públicos en México

<div class="page" title="Page 1"><div class="section"><div class="layoutArea"><div class="column"><p><span>El presente artículo analiza los diversos usos y significados que se presentan en la multiplicidad de espacios públicos y en sus liminalidades, en contextos urbanos y en configuraciones políticas determinadas, enmarcados en relaciones de género estructuralmente establecidas. De igual manera, se brindan elementos teórico-metodológicos para contribuir a la discusión sociológica del uso social de los espacios, el cual induce o inhibe el acceso y disfrute por parte de las mujeres y otros grupos tradicionalmente en desventaja. A partir del análisis de lugares como el parque, la calle y hasta los espacios virtuales —redes sociales y la Internet—, se exponen datos contundentes acerca de la desigualdad de la utilización, percepción y participación dentro del espacio público. </span></p></div></div></div></div>

Observed trends in the magnitude of socioeconomic and area-based inequalities in use of caesarean section in Ethiopia: a cross-sectional study

BackgroundIn Ethiopia, there is a paucity of studies on inequality in caesarean section using methodologically rigorous and well-established approaches. In this study, we showed extent and the overtime dynamics of inequality in caesarean section in Ethiopia following rigorous methodologies.MethodsThe data for analysis came from Ethiopia Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) to analyze the data. Caesarean delivery was disaggregated by four equity stratifiers, namely education, wealth, residence and regions. Relative and absolute summary measures were calculated for each equity stratifier to capture inequality from different perspectives. 95% Uncertainty Interval was calculated around a point estimate to measure statistical significance.ResultsWe found large socioeconomic and area-based inequalities in use of caesarean section in all study surveys. The inequalities have occurred in favour of socioeconomically advantaged women and those living in urban areas and certain regions such as Addis Ababa. While area-related inequality had generally increased with time, socioeconomic inequality showed fluctuation. Adoption of different measures in the study for the inequality analysis has caused the emergence of mix of patterns in caesarean section inequality over time.ConclusionsIn all the surveys, wealthy and more educated women, and those residing in urban areas had higher chance of obtaining caesarean delivery. Policy makers should work to ensure caesarean section that is in the accepted normal range. More emphasis should be drawn to subpopulation with under use of caesarean section while at the same time, discouraging unjustified use of it.

Monitoring the social gradient: Inequalities in use of blood pressure monitors in the HUNT study

AimTo investigate the cross-sectional and longitudinal social gradient in use of blood pressure monitors, an innovative health technology. BackgroundThis is one of the first studies of social inequalities in the utilization of an end-user health technology in a universal health care context. The diffusion of innovation (DoI) and fundamental cause (FCT) theories predicts a widening of inequalities with the introduction of a new technology. Data and methodsTwo waves (N > 18,000) of the Nord-Trøndelag Health Study (HUNT), conducted in 1997 and 2008. Dependent variables were three self-reported indicators of blood pressure monitor use. Independent variables were educational attainment and income quartiles. Control variables were gender, age, and blood pressure. ResultsFor the blood pressure monitor variable from 1997, there was evidence of an educational gradient. No social inequalities were found for the 2008 monitor variable. When interacting socio-economic status with a survey wave dummy, results showed a social gradient from 1997 becoming smaller or non-significant in 2008. These results are supportive of the DoI and FCT, suggesting that the use of technology may initially generate health inequalities, which decrease as the technology is diffused across all social strata.

Socioeconomic inequalities in reproductive health care services across Sub-Saharan Africa. A systematic review and meta-analysis

BackgroundWomen in Sub-Saharan African experience socioeconomic barriers in the use of reproductive health care services. This paper analyzes the evidence on socioeconomic inequalities in reproductive health care utilization in Sub-Saharan Africa and identifies the variance in the estimates of these inequalities. MethodsWe performed a systematic review and meta-analysis of studies on socioeconomic inequalities in the use of reproductive health care services published between January 2008 and June 2019. We used meta-regression to identify heterogeneity sources in reproductive care services use. ResultsTwenty-two studies were included and they reported 305 estimates of the concentration index for different reproductive health care services. We grouped the services into ten categories of reproductive health care services. Socioeconomic status was associated with inequality in reproductive health care use and was on average high, with a pro-wealthy inequality magnitude of the concentration index of 0.202. The meta-analysis indicated that inequality was highest for skilled childbirth services with an average concentration index of 0.343. The average concentration index for family planning and components of antenatal care was 0.268 and 0.142 respectively. Random-effects meta-regression showed that the heterogeneity in reproductive health care use was explained by contextual differences between countries. ConclusionThe magnitude of inequality in reproductive health care use varies with the type of service and the focus on skilled childbirth services through user fees removal appears to have fostered inequality. The one-size-fits-all approach to reproductive health care initiatives has ignored differences in reproductive health care needs and the ability to overcome use barriers.

The demographics of assisted reproductive technology births in a Nordic country.

STUDY QUESTIONWhat are the socio-demographic characteristics of families in Norway who have children after assisted reproductive technology (ART), and have these characteristics changed over time?SUMMARY ANSWERParents who conceive through ART in Norway tend to be advantaged families, and their socio-demographic profile has not changed considerably over the period 1985–2014.WHAT IS KNOWN ALREADYA small number of studies show that couples who conceive through ART tend to be socio-economically advantaged.STUDY DESIGN, SIZE, DURATIONNorwegian Population Register, the Medical Birth Register and the national data bases were linked to study all live births in Norway between 1985 and 2014.PARTICIPANTS/MATERIALS, SETTING, METHODSThe sample consisted of 1 757 768 live births. Simple bivariate analyses were performed to describe the socio-demographic characteristics of parents who conceived through ART and changes in these characteristics over the time period 1985–2014. We used linear probability models to estimate the association between parental income and giving birth after ART from 2000 to 2014, before and after adjustment for maternal age at delivery, education and area of residence.MAIN RESULTS AND THE ROLE OF CHANCEParents conceiving through ART were more likely to be older, with the highest levels of income and education, and married. Their socio-demographic profiles did not change considerably during the period 1985–2014. In the unadjusted model, parents belonging to the top income quartile were 4.2 percentage points more likely (95% CI: 4.1 to 4.3) to have conceived through ART than parents who belonged to the bottom income quartile. Adjustment for maternal age only partially reduced the income disparities (for the top income quartile by 35% (β = 2.7 with 95% CI: 2.5 to 2.8)). Additional adjustment for maternal education, marital status and area of residence did not further attenuate the associations.LIMITATIONS, REASONS FOR CAUTIONThe data does not enable us to tell whether the lower numbers of children conceived through ART amongst more disadvantaged individuals is caused by lower success rates with ART treatment, lower demand of ART services or barriers faced in access to ART. The study focuses on Norway, a context characterised by high subsidisation of ART services.WIDER IMPLICATIONS OF THE FINDINGSEven though in Norway access to ART services is highly subsidised, the results highlight important and persisting social inequities in use of ART. The results also indicate that children born after ART grow up in resourceful environments, which will benefit their development and well-being.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by European Research Council agreement n. 803959 (to A.G.), by Economic and Social Research Council grant ES/M001660/1 and by the Research Council of Norway through its Centres of Excellence funding scheme, project number 262700. The authors have no conflict of interest to declare.TRIAL REGISTRATION NUMBERNot applicable.

Socioeconomic inequalities in use and non-use of dental services in Poland

ObjectivesTo assess the impact of classical socioeconomic factors on the use and non-use of dental services on a representative sample of Polish population.MethodsThe study was based on face-to-face surveys conducted by GUS (Statistics Poland) on 13,376 respondents in 2010 and 12,532 individuals in 2013.ResultsThe percentage of people using dental services in the highest income group was approximately twice as high as that in the lowest one (Q1: 7.0% vs. Q5: 16.4%), with the same being true for education (the lowest education group: 8.3% vs. the highest education group: 18.0%), and place of residence (inhabitants of rural areas: 9.2% vs. inhabitants of largest cities: 15.9%) in 2013. The analysis has shown the disparities in not using dental services when in need to be less clear-cut.ConclusionsThe conducted research, based on two independent periods, a representative population sample, univariate analysis and the multivariate regression model has revealed pronounced social inequalities in dental care use. It is a challenge to determine the factors which contribute most to health inequalities and the interventions which are most effective in reducing them.

Socioeconomic differences in use of public, occupational and private health care: A register-linkage study of a working-age population in Finland.

There is little knowledge on socioeconomic differences in use of health care organized by different care schemes and on exclusive and concurrent use of health care at different schemes in different socioeconomic groups. In Finland, public, occupational and private schemes offer parallel outpatient primary health care services. Each scheme mainly reaches different population groups because of differences in availability, costs and gatekeeping. This study aimed to analyse how the probability of using health care organized by the three schemes differed by socioeconomic status in a working-age population. Individual-level register-based data on use of public, occupational and private outpatient primary health care during 2013 as well as data on sociodemographic covariates were linked for the total population aged 25–64 of the city of Oulu, Finland. Data were analysed with descriptive methods and multinomial logistic regression models. Those in the study population most often used only occupational care or only public care, or did not use any of the studied health care schemes at all. The lower the socioeconomic status, the higher was the probability of not using care or using only public care. The higher the socioeconomic status, the higher was the probability of using occupational care–either only occupational care or occupational care in combination with private care. Education, occupational class and income were all associated with care use also when adjusted for sociodemographic covariates and chronic disease, but income proved to be the strongest predictor of the three. The results reflect the design of the Finnish health care system, with a strong occupational health care scheme for the employed population contributing to inequality in use of health care and potentially to health inequality between socioeconomic groups.

Abstract 04: Gender and Racial Inequalities in the Use of Statins for Secondary Prevention of Cardiovascular Disease Remains Despite Persistent Recommendations in Recent Guidelines - A Call to Action

Introduction: Statins use for secondary cardiovascular disease (CVD) prevention is associated with better health outcomes and lower cost among adults with ASCVD. We aimed to examine the prevalence of statin use among adults with ASCVD in the US and to assess for gender and racial differences in statin use. Methods: We identified adults aged 40-75 years with ASCVD (defined using ICD codes and self-reported history) from the 2008-17 Medical Expenditure Panel Survey (MEPS) data. We estimated the trends in statin use among them, and used joint point regression (JPR) to estimate the annual percentage change in statin use. Logistic regression was used to assess the racial variation in statin use. We applied the weights in the MEPS complex survey design to estimate population sizes, so all results are nationally representative. Results: Between 2008 and 2017, 24896 adults aged 40-75 years with ASCVD were identified. In 2017, there were 2445 patients with ASCVD (equivalent to 24.5 million adults). In 2017, the mean age [SE] was 62.2 [0.3] years, and 42.9% were females. The overall proportion of adults with ASCVD using statin increased from 50.0% in 2008 to 58.7% in 2017, with an average annual percentage change of 0.95% between 2010 and 2017 ( p= 0.01). As shown in Figure 1a , among those with ASCVD, statin use was persistently lower in women than in men. In 2017, compared to White adults with ASCVD, Blacks (OR=0.69; 95% CI: 0.51-0.92) and Hispanics (OR=0.62; 95% CI: 0.45-0.85) were less likely to be on statin. Each year, over 3 million women with ASCVD were not on statin, and majority of them were Blacks and Hispanics. (Figure 1b) Conclusion: Millions of adults with ASCVD are not on statins in the US while gender and racial inequalities in statin use remains, despite persistent guideline recommendations. Herein lies an opportunity to improve CVD-related outcomes and cost by intensifying efforts to use statins for the secondary prevention of CVD and closing gender and racial gaps, especially with the 2030 sustainable development goals in view.

The use of health care services in the Great Recession: evaluating inequalities in the Spanish context

ObjectiveTo analyse the effect of the Great Recession (2008) on primary care (PC) and secondary care (SC) inequalities in Spain. MethodRepeated cross-sectional study using Spanish Health Surveys from 2001 to 2017 (n=139,566). Prevalence of PC and SC utilization were calculated standardized by age. Chi square tests for trend were conducted to explore the evolution. We performed logistic regression analyses adjusted by the Andersen's model of demand for care to explore inequalities prior to, during and following the recession. All the analyses were stratified by sex. ResultsHealthcare use trends changed from a rapid increase in the pre-recession period to a plateau during the recession and a decrease in the post-recession period. Healthcare use was higher in women (PC: 15.8% to 32.5%; SC: 8.2% to 16.2%) than in men (PC: 11.3% to 24.1%; SC: 5.4% to 11.6%) and the gender gap increased. During the recession the likelihood of PC use was higher in disadvantaged groups, while SC had greater usage amongst more advantaged social groups. Inequalities in SC use increased during the recession and could not be attributed to factors of need. ConclusionsHealthcare use trends changed as a result of the recession. There are socioeconomic inequalities in the use of PC and SC in Spain, which increased in secondary care, during the recession and in the post-recession period. It is necessary to take into account socioeconomic determinants in health planning, in order to achieve equity in healthcare services.

Inequities in neighborhood public park use for schoolchildren’s physical activity: multilevel evidence from Cordoba, Argentina

The complexity of urbanization processes across Latin American societies encourages investigating its implications in health conditions, especially during childhood. One of the possible links between them is recreation, a component of the daily life of children and, therefore, essential to produce health and life itself. The objective of this study was to examine the associations between neighborhood context and active public park use among school-aged children in Cordoba, Argentina. A cross-sectional study was conducted with 1466 children, aged 9 to 11, attending 19 schools and living in 110 neighborhoods. Multilevel models with Poisson distribution were used for the analyses, stratified by gender. Socio-demographic, behavioral, and physical covariates were included at the individual level, and socioeconomic neighborhood conditions at second level. Girls residing in neighborhoods with a worse socioeconomic context were less likely to report frequent public park use for physical activity, while those from neighborhoods with better socioeconomic conditions were more likely to, regardless of individual characteristics. This study suggests that socioeconomic conditions of neighborhoods are associated with public park use for physical activity in school-aged girls, demonstrating gender inequality in the use and appropriation of public spaces.

Applying inequalities to calculating limits

In this article considered the use of inequalities to find the limits of fairly complex sequences. To this end, proved a few inequalities and with the help of these inequalities calculate limits.

Socio-economic inequality and inequity in use of health care services in Kenya: evidence from the fourth Kenya household health expenditure and utilization survey

BackgroundKenya is experiencing persistently high levels of inequity in health and access to care services. In 2018, decades of sustained policy efforts to promote equitable, affordable and quality health services have culminated in the launch of a universal health coverage scheme, initially piloted in four Kenyan counties and planned for national rollout by 2022. Our study aims to contribute to monitoring and evaluation efforts alongside policy implementation, by establishing a detailed, baseline assessment of socio-economic inequality and inequity in health care utilization in Kenya shortly before the policy launch.MethodsWe use concentration curves and corrected concentration indexes to measure socio-economic inequality in care use and the horizontal inequity index as a measure of inequity in care utilization for three types of care services: outpatient care, inpatient care and preventive and promotive care. Further insights into the individual and household level characteristics that determine observed inequality are derived through decomposition analysis.ResultsWe find significant inequality and inequity in the use of all types of care services favouring richer population groups, with particularly pronounced levels for preventive and inpatient care services. These are driven primarily by differences in living standards and educational achievement, while the region of residence is a key driver for inequality in preventive care use only. Pro-rich inequalities are particularly pronounced for care provided in privately owned facilities, while public providers serve a much larger share of individuals from lower socio-economic groups.ConclusionsThrough its focus on increasing affordability of care for all Kenyans, the newly launched universal health coverage scheme represents a crucial step towards reducing disparities in health care utilization. However in order to achieve equity in health and access to care such efforts must be paralleled by multi-sectoral approaches to address all key drivers of inequity: persistent poverty, disparities in living standards and educational achievement, as well as regional differences in availability and accessibility of care.

English

Inequality, also known as inequation, but unlike equation does not have rich history. After the introduction of equation, inequation captures its popularity in different fields namely algebra, geometry, trigonometry, probability, set theory, fuzzy set theory, logic, calculus etc. Whereas inequalities used in algebra are called algebraic inequalities, the ones used in geometry are called geometric inequalities etc. However, if the same techniques used in solving an equation are used for an inequation, wrong results may be obtained. Unlike equation, it has limited applications. When two quantities or expressions are not the same, then we use inequality and it is written by cross-out equal sign ( ) or . From a logical point of view, there is a difference between and . Sometimes we explain inequalities in linguistic form to describe the social values. All the above discussions on inequalities have been done according to the classical sense. In view of the present situation, it is necessary to extend this concept to fuzzy sense. Many researchers and mathematicians have shown the use of inequalities in fuzzy set, intuitionistic fuzzy set, soft set, rough set etc to describe the imprecise data. In this paper, some results related to inequalities of interval-valued intuitionistic fuzzy matrices with respect to algebraic sum and algebraic product were studied and proven. Key words: Fuzzy matrix, Interval-valued intuitionistic fuzzy matrix, algebraic sum, algebraic product.

Assessing the impact on inequalities in use of orthodontic services of the introduction of an objective measure of treatment need in Northern Ireland

Background with rationalePrevious work has shown the existence of a sharp socio-economic gradient with respect to orthodontic services in Northern Ireland. The work demonstrated that those of lower socio-economic status had an odds ratio of 0.79 (95% CI 0.69 - 0.91) compared to those of higher socio-economic status with respect to the consumption of orthodontic services. In response to this, an objective measure of treatment need for such publicly funded services was introduced in 2014.
 Main AimThis study will use a record-linkage methodology to examine the relationship between use of publicly funded orthodontic care and the introduction of the index of treatment need (IOTN) in Northern Ireland in 2014.
 Methods/ApproachFollowing a similar approach to that used previously, data related to use of orthodontic services was linked to socio-economic characteristics from the 2011 Census for members of the Northern Ireland Longitudinal Study. The relationship between socio-economic status and uptake of orthodontic services in the 3 years before and after the introduction of IOTN will be examined using an interrupted time series analysis as well as by the comparison of concentration indices across the study period.
 ResultsAll results must be cleared by the Northern Ireland Statistical Research Agency before release. We expect cleared results to be available imminently and anticipate these showing a change in the uptake of publicly funded orthodontic services as well as a reduction in the socio-economic gradient over time.
 ConclusionThe identification of inequalities in the use of publicly funded services requires an appropriate policy response. We anticipate that the introduction of IOTN as a criterion for access to publicly funded care will have successfully reduced the use of such services unrelated to need and the existence of inequalities in service use conditioned on need.

Social Inequalities in Use of Preventive Dental and Medical Services among Adults in European Countries

This study examined inequalities in dental check-ups and medical screenings using subjective and objective socioeconomic indicators. Data from 23,464 adults, aged 20 years old and over, who participated in a multi-national survey across Europe (Eurobarometer 72.3) were analysed. Participants’ socioeconomic position (SEP) was measured by education, difficulty in paying bills and subjective social status. Use of preventive services was measured by attendance for dental check-ups, cancer and cardiovascular screenings in the past 12 months. Socioeconomic inequalities were assessed in two-level logistic regression (adults nested within countries), adjusting for demographic factors and type of healthcare system. There were apparent social inequalities in using all three preventive services. However, only dental check-ups showed consistent and significant inequalities across all socioeconomic indicators with those in the bottom groups in education (odds ratio: 0.51; 95% confidence interval: 0.46–0.55), difficulty in paying bills (OR: 0.64; 95% CI: 0.59–0.72) and subjective social status (OR: 0.63; 95% CI: 0.57–0.69) having lower odds of reporting dental check-ups in the past 12 months than those in the top groups. Cancer screening was not associated with difficulty in paying bills whereas cardiovascular disease screening was not associated with education and subjective social status. Despite the availability of universal health coverage, there were clear social gradients in using preventive services particularly across education and subjective social status groups. The stronger and more consistent gradients observed in dental check-ups compared to cancer and cardiovascular screening could be attributed to difference in the level of coverage of dental and medical services in Europe.

Does gender inequality affect household green consumption behaviour in China?

In this paper, we examine whether gender inequality affects a household's decision to adopt green consumption behaviour in China. Building upon the literature that claims women tend to be more environmentally friendly than men, we hypothesise that households in which women play a stronger role adopt greener consumption lifestyles. Based on a nationwide survey, our empirical results show that households in counties with greater gender inequality use less energy-efficient electric products and are less willing to save energy. The results are robust to a number of variations in our empirical models. Social and economic factors are included to further explore the mechanisms underlying households' decisions. Our findings provide new insights into green development from a micro-level, bottom-up perspective. They are relevant for policy makers because they indicate that promoting gender equality can have a favourable impact on green development.

Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data

BackgroundInappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it.MethodsData from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities.ResultsOut of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile .ConclusionsThis study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana’s free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies.

Unmet need for health care during pregnancy: A French – Romanian comparison

ABSTRACTHealth inequalities emerge from birth, the early neonatal mortality and infant mortality rates being different between countries. These differences may be related to inequalities in use of health care during pregnancy. The aim of this research is to identify and compare the profiles of women who do not follow pregnancy health care recommendations in two European countries with different health systems and indicators: namely France and Romania. However, health care recommendations for pregnant women are free in the two countries. Firstly, unmet need for health care during pregnancy is observed. Secondly, our results reveal that there is a relationship between perinatal health care abandonment and several forms of inequalities (social, informational and psychological). Thirdly, the much higher probability of forgoing perinatal health care for Romanian women could be associated with financial or informational problems which seems counterintuitive because perinatal health care recommendations are free. Free coverage is too insufficient to ensure the efficiency of the perinatal health care system.

Inequalities in the utilization of maternal health care in the pre- and post-National Health Mission periods in India.

Since the implementation of the National Health Mission (NHM) in India there has been a noticeable improvement in the utilization of maternal care, namely antenatal care (ANC), skilled birth attendants (SBA) and postnatal care (PNC) in the country. The increase in utilization of these services is expected to reduce inequality across geographies and population sub-groups, but little is known about the extent of inequality in maternal care use across socioeconomic groups over time. Using data from the last two rounds of National Family Health Surveys conducted in 2005-06 and 2015-16, this study examined the extent of inequality in utilization of full ANC, SBA and PNC in India and its states. Descriptive statistics were used, a concentration index was computed and decomposition analyses performed to understand the pattern and change of inequality in use of maternal care. The results suggest that the gap in maternal care utilization across socioeconomic groups has reduced over time. The concentration index for SBA showed a decline from 0.49 in 2005-06 to 0.08 by 2015-16, while that of PNC declined from 0.36 to 0.13 over the same period. The reduction in inequality in utilization of full PNC was the least. The results of the decomposition analysis revealed that urban residence, education and belonging to Scheduled Caste and Scheduled Tribes positively contributed to the inequality. Based on these findings, it is suggested that the Janani Suraksha Yojana and Janani Sishu Suraksha Karyakaram schemes be continued and strengthened for poor mothers to reduce maternal health inequality, particularly in full ANC and PNC.