Horizontal Inequity in the Utilisation of Continuum of Maternal Health Care Services in India: An Investigation of Pre and Post-NRHM Period

Background-Continuum of Maternal Health Care Services (CMHS) have garnered attention in the recent times and reducing socio-economic disparity and geographical variations in its utilisation becomes crucial from an egalitarian perspective. In this study, we have estimated inequity in the utilisation of CMHS in India between 2005-06 and 2015-16. Methods-We used two rounds of National Family Health Survey (NFHS) - 2005-06 and 2015-16 encompassing a sample size of 34,560 and 178,857 pregnant women respectively. The magnitude and variations in horizontal inequities (HI) in the utilisation of CMHS was captured by adopting Erreygers Corrected Concentration indices method. Need-based standardisation was conducted to disentangle the variations in the utilisation of CMHS across different wealth quintiles and state groups. Followed by this, a decomposition analysis was undertaken to enumerate the contribution of legitimate and illegitimate factors towards health inequity. Results-The study indicated the pro-rich inequity in the utilisation of CMHS have increased by around 2 percentage points since the implementation of National Rural Health Mission (NRHM). Majority of contribution was made by illegitimate factors. Decomposition analysis revealed that the contribution of access related barriers plummeted in the considered period of time. While, mother’s education and access to media continuous to remain major contributors of pro-rich inequity in India. Region-wide variations were quite pervasive- percentage of pro-rich inequity in high focused group states increased by around 3% between 2005-06 and 2015-16. Among states, the performance of southern states of India are commendable. We suggest that, special attention to vulnerable sections is paramount to ensure equitable distribution of CMHS.