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Economic Inequalities in Maternal Health Care: Prenatal Care and Skilled Birth Attendance in India, 1992–2006

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  • Praveen Kumar Pathak
  • Abhishek Singh
  • S V Subramanian

Abstract

Background: The use of maternal health care is limited in India despite several programmatic efforts for its improvement since the late 1980's. The use of maternal health care is typically patterned on socioeconomic and cultural contours. However, there is no clear perspective about how socioeconomic differences over time have contributed towards the use of maternal health care in India. Methodology/Principal Findings: Using data from three rounds of National Family Health Survey (NFHS) conducted during 1992–2006, we analyse the trends and patterns in utilization of prenatal care (PNC) in first trimester with four or more antenatal care visits and skilled birth attendance (SBA) among poor and nonpoor mothers, disaggregated by area of residence in India and three contrasting provinces, namely, Uttar Pradesh, Maharashtra and Tamil Nadu. In addition, we investigate the relative contribution of public and private health facilities in meeting the demand for SBA, especially among poor mothers. We also examine the role of salient socioeconomic, demographic and cultural factors in influencing aforementioned outcomes. Bivariate analyses, concentration curve and concentration index, logistic regression and multinomial logistic regression models are used to understand the trends, patterns and predictors of the two outcome variables. Results indicate sluggish progress in utilization of PNC and SBA in India and selected provinces during 1992–2006. Enormous inequalities in utilization of PNC and SBA were observed largely to the disadvantage of the poor. Multivariate analysis suggests growing inequalities in utilization of the two outcomes across different economic groups. Conclusions: The use of PNC and SBA remains disproportionately lower among poor mothers in India irrespective of area of residence and province. Despite several governmental efforts to increase access and coverage of delivery services to poor, it is clear that the poor (a) do not use SBA and (b) even if they had SBA, they were more likely to use the private providers.

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  • Praveen Kumar Pathak & Abhishek Singh & S V Subramanian, 2010. "Economic Inequalities in Maternal Health Care: Prenatal Care and Skilled Birth Attendance in India, 1992–2006," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-17, October.
    • Handle: RePEc:plo:pone00:0013593
    DOI: 10.1371/journal.pone.0013593
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    8. Joshua Amo-Adjei & Kofi Aduo-Adjei & Christiana Opoku-Nyamah & Chimaroake Izugbara, 2018. "Analysis of socioeconomic differences in the quality of antenatal services in low and middle-income countries (LMICs)," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-12, February.
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    11. Ghosh, Arabinda, 2011. "Maternal health care in Indian districts," Health Policy, Elsevier, vol. 103(2), pages 290-296.
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    15. Zafer Çalışkan & Dilek Kılıç & Selcen Öztürk & Emre Atılgan, 2015. "Equity in maternal health care service utilization: a systematic review for developing countries," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 60(7), pages 815-825, November.
    16. Madhu Gupta & Federica Angeli & Hans Bosma & Monica Rana & Shankar Prinja & Rajesh Kumar & Onno C P van Schayck, 2016. "Effectiveness of Multiple-Strategy Community Intervention in Reducing Geographical, Socioeconomic and Gender Based Inequalities in Maternal and Child Health Outcomes in Haryana, India," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-13, March.
    17. Mary O. Obiyan & Abhishek Kumar, 2015. "Socioeconomic Inequalities in the Use of Maternal Health Care Services in Nigeria," SAGE Open, , vol. 5(4), pages 21582440156, November.
    18. Pathak, Praveen Kumar & Singh, Abhishek, 2011. "Trends in malnutrition among children in India: Growing inequalities across different economic groups," Social Science & Medicine, Elsevier, vol. 73(4), pages 576-585, August.
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    20. Md Mobarak Hossain Khan & Arina Zanuzdana & Alexander Kraemer, 2013. "Levels, Trends and Disparities in Public-Health-Related Indicators among Reproductive-Age Women in Bangladesh by Urban-Rural and Richest-Poorest Groups, 1993-2011," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-1, September.
    21. Gudrun Østby & Henrik Urdal & Andreas Forø Tollefsen & Andreas Kotsadam & Ragnhild Belbo & Christin Ormhaug, 2018. "Organized Violence and Institutional Child Delivery: Micro-Level Evidence From Sub-Saharan Africa, 1989–2014," Demography, Springer;Population Association of America (PAA), vol. 55(4), pages 1295-1316, August.
    22. Aizawa, T.;, 2019. "Reviewing the Existing Evidence of the Conditional Cash Transfer in India through the Partial Identification Approach," Health, Econometrics and Data Group (HEDG) Working Papers 19/24, HEDG, c/o Department of Economics, University of York.

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