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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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    14. 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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    17. Abhishek Singh & Praveen Kumar Pathak & Rajesh Kumar Chauhan & William Pan, 2011. "Infant and Child Mortality in India in the Last Two Decades: A Geospatial Analysis," PLOS ONE, Public Library of Science, vol. 6(11), pages 1-19, November.
    18. Das, Upasak & Biswas, Shreya, 2023. "Fuelling down after a lockdown: Effects of the first COVID wave on clean fuel usage in India," Energy Economics, Elsevier, vol. 126(C).
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