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Jung S, Chi H, Eom YJ, Subramanian S, Kim R. Multilevel analysis of determinants in postnatal care utilisation among mother-newborn pairs in India, 2019-21. J Glob Health 2024; 14:04085. [PMID: 38721673 PMCID: PMC11079700 DOI: 10.7189/jogh.14.04085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Postnatal care (PNC) utilisation within 24 hours of delivery is a critical component of health care services for mothers and newborns. While substantial geographic variations in various health outcomes have been documented in India, there remains a lack of understanding regarding PNC utilisation and underlying factors accounting for these geographic variations. In this study, we aimed to partition and explain the variation in PNC utilisation across multiple geographic levels in India. Methods Using India's 5th National Family Health Survey (2019-21), we conducted four-level logistic regression analyses to partition the total geographic variation in PNC utilisation by state, district, and cluster levels, and to quantify how much of theses variations are explained by a set of 12 demographic, socioeconomic, and pregnancy-related factors. We also conducted analyses stratified by selected states/union territories. Results Among 149 622 mother-newborn pairs, 82.29% of mothers and 84.92% of newborns were reported to have received PNC within 24 hours of delivery. In the null model, more than half (56.64%) of the total geographic variation in mother's PNC utilisation was attributed to clusters, followed by 26.06% to states/union territories, and 17.30% to districts. Almost 30% of the between-state variation in mother's PNC utilisation was explained by the demographic, socioeconomic, and pregnancy-related factors (i.e. state level variance reduced from 0.486 (95% confidence interval (CI) = 0.238, 0.735) to 0.320 (95% CI = 0.152, 0.488)). We observed consistent results for newborn's PNC utilisation. State-specific analyses showed substantial geographic variation attributed to clusters across all selected states/union territories. Conclusions Our findings highlight the consistently large cluster variation in PNC utilisation that remains unexplained by compositional effects. Future studies should explore contextual drivers of cluster variation in PNC utilisation to inform and design interventions aimed to improve maternal and child health.
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Affiliation(s)
- Sohee Jung
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Hyejun Chi
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
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Dewidar O, McHale G, Al Zubaidi A, Bondok M, Abdelrazeq L, Huang J, Jearvis A, Aliyeva K, Alghamyan A, Jahel F, Greer-Smith R, Tufte J, Barker LC, Elmestekawy N, Sharp MK, Horsley T, Prats CJ, Jull J, Wolfenden L, Cuervo LG, Hardy BJ, Roberts JH, Ghogomu E, Obuku E, Owusu-Addo E, Nicholls SG, Mbuagbaw L, Funnell S, Shea B, Rizvi A, Tugwell P, Bhutta Z, Welch V, Melendez-Torres GJ. Motivations for investigating health inequities in observational epidemiology: a content analysis of 320 studies. J Clin Epidemiol 2024; 168:111283. [PMID: 38369078 DOI: 10.1016/j.jclinepi.2024.111283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES To enhance equity in clinical and epidemiological research, it is crucial to understand researcher motivations for conducting equity-relevant studies. Therefore, we evaluated author motivations in a randomly selected sample of equity-relevant observational studies published during the COVID-19 pandemic. STUDY DESIGN AND SETTING We searched MEDLINE for studies from 2020 to 2022, resulting in 16,828 references. We randomly selected 320 studies purposefully sampled across income setting (high vs low-middle-income), COVID-19 topic (vs non-COVID-19), and focus on populations experiencing inequities. Of those, 206 explicitly mentioned motivations which we analyzed thematically. We used discourse analysis to investigate the reasons behind emerging motivations. RESULTS We identified the following motivations: (1) examining health disparities, (2) tackling social determinants to improve access, and (3) addressing knowledge gaps in health equity. Discourse analysis showed motivations stem from commitments to social justice and recognizing the importance of highlighting it in research. Other discourses included aspiring to improve health-care efficiency, wanting to understand cause-effect relationships, and seeking to contribute to an equitable evidence base. CONCLUSION Understanding researchers' motivations for assessing health equity can aid in developing guidance that tailors to their needs. We will consider these motivations in developing and sharing equity guidance to better meet researchers' needs.
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Affiliation(s)
- Omar Dewidar
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Bruyère Research Institute, University of Ottawa, Ottawa, Canada.
| | - Georgia McHale
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Ali Al Zubaidi
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada; School of Medicine, University College Cork, Cork, Ireland
| | - Mostafa Bondok
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Leenah Abdelrazeq
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada; Department of Health Sciences, Carelton University, Ottawa, Canada
| | - Jimmy Huang
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Alyssa Jearvis
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Khadija Aliyeva
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Amjad Alghamyan
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Fatima Jahel
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | | | | | - Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, Canada; Women's College Hospital, Toronto, Canada
| | - Nour Elmestekawy
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Melissa K Sharp
- Department of General Practice, Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Clara Juandro Prats
- Applied Health Research Center, St. Michael's Hospital, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Luke Wolfenden
- Cochrane Public Health, School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia
| | - Luis Gabriel Cuervo
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization (PAHO/WHO), Washington, DC, USA; Department of Paediatrics, Obstetrics & Gynaecology, and Preventive Medicine, Doctoral School, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Billie-Jo Hardy
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janet Hatchet Roberts
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Ottawa, Canada
| | | | - Ekwaro Obuku
- Africa Centre for Systematic Reviews & Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ebenezer Owusu-Addo
- Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sarah Funnell
- Department of Family Medicine, Queen's University, Kingston, Canada; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Bev Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Anita Rizvi
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Zulfiqar Bhutta
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Centre for Excellence in Women and Child Health and Institute of Global Health and Development, The Aga Khan University, Karachi, Pakistan
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Kusuma YS, Kumari A, Rajbangshi P, Ashraf Ganie M, Sarala R, Kumar D, Kalaiselvi S, Kanungo S, Jain N, Singh R, Kumar S, Dutt Gupta S, Babu BV. Maternal healthcare seeking and determinants of adequate antenatal care and institutional childbirth among Indian tribes: A cross-sectional study from nine districts. Eur J Obstet Gynecol Reprod Biol 2024; 292:163-174. [PMID: 38016417 DOI: 10.1016/j.ejogrb.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/22/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To report the utilisation of maternal healthcare services and factors associated with adequate antenatal care and institutional childbirths among mothers in the tribal communities from nine districts in India. METHODS Cross-sectional data were collected from 2636 tribal women who had a childbirth experience in the past 12 months. Socio-demographic, maternal healthcare services and health system-related details were collected. Multiple logistic regression analyses were done to identify factors associated with adequate antenatal care (receiving at least four antenatal care visits, the first visit being in the first trimester and receiving a minimum of 100 iron-folic acid tablets) and institutional childbirth (mother giving birth in a health facility). RESULTS Only 23% of the mothers received adequate antenatal care. 82% were institutional childbirths. The logistic regression revealed that particularly vulnerable tribal groups (PVTGs), those lacking all-weather roads, and women of advanced age were at risk of inadequate antenatal care. Mother's education, health worker's home visits during pregnancy and reception of advice on antenatal care were significantly associated with the reception of adequate antenatal care. Having all-weather roads, and education of the mother and head of the household were positively associated with institutional childbirths, whereas PVTGs, children of birth order three or above, and working mothers were more likely to give childbirth at home. CONCLUSION PVTGs are at risk of foregoing adequate antenatal care and are more likely to give childbirth at home. Having all-weather roads is a strong correlate of adequate maternal care. Outreach activities by the health workers are to be strengthened as they are positively and significantly associated with the reception of adequate antenatal care. Investing in education and other social determinants and addressing certain socio-cultural practices is important to improve maternal health.
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Affiliation(s)
- Yadlapalli S Kusuma
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anjali Kumari
- Socio-Behavioural, Health Systems and Implementation Research Division, Indian Council of Medical Research, New Delhi, India
| | | | | | - Raju Sarala
- Indian Institute for Health Management Research, Bangalore, India
| | - Dinesh Kumar
- Indian Council of Medical Research-National Institute of Research in Tribal Health, Jabalpur, India
| | - Selvaraj Kalaiselvi
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Srikanta Kanungo
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Nutan Jain
- Indian Institute for Health Management Research University, Jaipur 302029, India
| | - Rajesh Singh
- Garhwal Community Development & Welfare Society, Chamba, Tehri-Garhwal, India
| | - Satish Kumar
- International Institute for Health Management Research, New Delhi, India
| | - Shiv Dutt Gupta
- Indian Institute for Health Management Research University, Jaipur 302029, India
| | - Bontha V Babu
- Socio-Behavioural, Health Systems and Implementation Research Division, Indian Council of Medical Research, New Delhi, India.
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Kalra H, Tran T, Romero L, Sagar R, Fisher J. National policies and programs for perinatal mental health in India: A systematic review. Asian J Psychiatr 2024; 91:103836. [PMID: 37988929 DOI: 10.1016/j.ajp.2023.103836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND India is the most populous country in the world with millions of births annually. Perinatal mental disorders (PMDs) are prevalent worldwide including in India. This study was undertaken to evaluate how mental health is addressed in national maternity and mental health policies and programs in India. METHODS We conducted a systematic review of the national policies and programs in India related to maternity care and mental health. The identified policies and programs were analysed using health policy triangle framework. RESULTS Our search yielded 11 relevant documents and no peer reviewed publications. No specific national policy or program on maternal mental health could be identified. Universal access to health and mental health including for women and children was clearly articulated in both national mental health and maternity policies, which emphasised that access to mental health care and treatment is a fundamental right. There were few details about how the programs and policies were developed and no accounts of consultations with community members or service providers in their formation. CONCLUSION National maternity and mental health policies and programs in India appear not to consider perinatal mental health. There are promising state-based initiatives, but, given the disease burden of PMDs in India, the absence of a national policy leads to unrecognized and unmet needs of women in the states without these measures. These inequalities can be effectively minimized by well implemented national policies for perinatal mental health, accompanied by evidence-based locally tailored programs and interventions across the country.
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Affiliation(s)
- Harish Kalra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; University of Notre Dame Australia.
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Beitze DE, Kavira Malengera C, Barhwamire Kabesha T, Frank J, Scherbaum V. Disparities in health and nutrition between semi-urban and rural mothers and birth outcomes of their newborns in Bukavu, DR Congo: a baseline assessment. Prim Health Care Res Dev 2023; 24:e61. [PMID: 37870120 PMCID: PMC10594532 DOI: 10.1017/s1463423623000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/24/2023] Open
Abstract
AIM This research aimed to evaluate health and nutritional practices of mothers during pregnancy and birth outcomes of their newborns in Bukavu, Democratic Republic of the Congo (DRC), comparing semi-urban and rural areas. BACKGROUND Health and nutrition during pregnancy are crucial for adequate development of the fetus. Health care plays an important role but is often poor in rural areas of developing countries. METHODS A baseline survey of a nutritional follow-up study was conducted in two semi-urban and one rural hospital in the vicinity of Bukavu, DRC. In total, 471 mother-child pairs were recruited after delivery. Data collection included socio-demographic parameters, nutrition and health measures during pregnancy, and anthropometric parameters. Semi-urban and rural study locations were compared and predictors of birth weight evaluated. FINDINGS Semi-urban and rural mothers differed significantly in nutrition and health practices during pregnancy, as well as birth outcomes. In the rural area, there was a higher rate of newborns with low birth weight (10.7%) and lower rates of antimalarial medication (80.8%), deworming (24.6%), consumption of nutritional supplements (81.5%), and being informed about nutrition by medical staff (32.8%) during pregnancy as well as practicing family planning (3.1%) than in the semi-urban areas (2.7%, 88.6%, 88.3%; 89.3%, 46.5%, and 17.1%, respectively). Birth weight was positively predicted by increasing maternal MUAC, age, and gestational age and negatively by rural location, being primipara, being a farmer, and female newborn sex. CONCLUSION The findings highlight the importance of strengthening antenatal care activities especially in rural areas in order to ameliorate both maternal and infantile health and ensure appropriate development.
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Affiliation(s)
| | - Céline Kavira Malengera
- School of Public Health, Faculty of Medicine, Université de Goma, Goma, DR Congo
- School of Medicine and Public Health, Université Evangélique en Afrique, Bukavu, DR Congo
- Département de Nutrition, Centre de Recherche en Sciences Naturelles/Lwiro, D.S. Bukavu, DR Congo
| | - Theophile Barhwamire Kabesha
- School of Medicine and Public Health, Université Evangélique en Afrique, Bukavu, DR Congo
- Faculty of Medicine, Official University of Bukavu, Bukavu, DR Congo
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
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Paul PL, Pandey S. An examination of the factors associated with male partner attendance in antenatal care in India. BMC Pregnancy Childbirth 2023; 23:532. [PMID: 37481558 PMCID: PMC10362642 DOI: 10.1186/s12884-023-05851-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/12/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND A growing body of literature indicates that including male partners in antenatal care can be instrumental to improving women's health service utilization and maternal and child health outcomes. Despite this, very few studies have documented overall trends in male partner attendance and what factors influence this involvement within the Indian context. In this study, we used nationally representative data to examine levels of male partner attendance in antenatal care and the factors associated with male partner attendance. METHODS Data were used from the National Family Health Survey (NFHS-4) conducted in 2015-16. Weighted (probability weights) descriptive statistics were conducted to summarize the level of male partner attendance in antenatal care in India, and multivariable logistic regression models were constructed to estimate the factors associated with male partner attendance in antenatal care. RESULTS In 2015, of the women who had attended at least one antenatal care contact during their pregnancy, about 85% reported that their male partners had accompanied them to antenatal care contacts, with variations across regions. Level of education, household wealth, knowledge of pregnancy-related issues, men's age at marriage, region, and women's level of autonomy emerged as significant predictors of male partner attendance in antenatal care. CONCLUSIONS The results of this study highlight the multiple influences that shape male partners' attendance in antenatal care. The findings underscore the need for a multi-faceted approach to programs and interventions aimed at encouraging male partner involvement; recognizing men both as individuals, as well as being situated within the family/household and community.
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Affiliation(s)
- Pooja L Paul
- Department of Social Work, Umeå University, Umeå, 901 87, Sweden.
| | - Shanta Pandey
- School of Social Work, Boston College, Chestnut Hill, MA, USA
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Raj P, Gupta N. A Review of the National Family Health Survey Data in Addressing India’s Maternal Health Situation. Public Health Rev 2022; 43:1604825. [DOI: 10.3389/phrs.2022.1604825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: This study aims to understand the trend of research conducted on issues of maternal health in India considering data provided in five rounds of National Family Health Survey (NFHS).Methods: Systematic review of literature has been conducted using multi-stage search and review process adapted from Page et al.’s (2021) PRISMA. Initially 14,570 studies were identified and only 134 articles meeting selection criterion were considered in this study.Results: Approximately 32% studies have focused on regional and state variation of maternal health status; while 27% dealt with utilization of maternal healthcare services; and 19% the socio-economic determinants of maternal health. While few studies have discussed the place of delivery, antenatal care and post-natal care visits, only five studies focus on issues related to women’s autonomy, including their health-seeking behaviour, knowledge, attitude and practices related to maternal health.Conclusion: Non-communicable diseases and its role in maternal health still remains an unexplored domain of research on maternal health in India. Moreover, there exists geographical skewness in the number of studies conducted, focusing especially on few provinces while none on few others.
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Kiran T, Junaid KP, Rajagopal V, Gupta M, Sharma D. Measurement and mapping of maternal health service coverage through a novel composite index: a sub-national level analysis in India. BMC Pregnancy Childbirth 2022; 22:761. [PMID: 36217107 PMCID: PMC9552458 DOI: 10.1186/s12884-022-05080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/27/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Expansion of maternal health service coverage is crucial for the survival and wellbeing of both mother and child. To date, limited literature exists on the measurement of maternal health service coverage at the sub-national level in India. The prime objectives of the study were to comprehensively measure the maternal health service coverage by generating a composite index, map India by categorizing it into low, medium and high zones and examine its incremental changes over time. METHODS Utilising a nationally representative time series data of 15 key indicators spread across three domains of antenatal care, intranatal care and postnatal care, we constructed a novel 'Maternal Health Service Coverage Index' (MHSI) for 29 states and 5 union territories of India for the base (2017-18) and reference (2019-20) years. Following a rigorous procedure, MHSI scores were generated using both arithmetic mean and geometric mean approaches. We categorized India into low, medium and high maternal health service coverage zones and further generated geospatial maps to examine the extent and transition of maternal health service coverage from base to reference year. RESULTS India registered the highest mean percentage coverage (93.7%) for 'institutional delivery' and the lowest for 'treatment for obstetric complications' (9.3%) among all the indicators. Depending on the usage of arithmetic mean and geometric mean approaches, the maternal health service coverage index score for India exhibited marginal incremental change (between 0.015-0.019 index points) in the reference year. West zone exhibited an upward transition in the coverage of maternal health service indicators, while none of the zones recorded a downward movement. The states of Mizoram (east zone) and the Union Territory of Puducherry (south zone) showed a downward transition. Union territories of Dadra & Nagar Haveli (west zone) and Chandigarh (north zone), along with the states of Maharashtra (west zone), Assam, as well as Jharkhand (both from the east & north east zone), showed upward transition. CONCLUSION Overall, maternal health service coverage is increasing across India. Our study offers a novel summary measure to comprehensively quantify the coverage of maternal health services, which can momentously help India identify lagged indicators and low performing regions, thereby warranting the targeted interventions and concentrated programmatic efforts to bolster the maternal health service coverage at the sub-national level.
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Affiliation(s)
- Tanvi Kiran
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K P Junaid
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Vineeth Rajagopal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divya Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Singh RR, Mishra S, Mohanty SK. Are cesarean deliveries equitable in India: assessment using benefit incidence analysis. BMC Health Serv Res 2022; 22:670. [PMID: 35585584 PMCID: PMC9118745 DOI: 10.1186/s12913-022-07984-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the last two decades, cesarean section (CS) deliveries in India have increased by six-fold and created economic hardship for families and households. Although several schemes and policies under the National Health Mission (NHM) have reduced the inequality in the use of maternal care services in India, the distributive effect of public health subsidies on CS deliveries remains unclear. In this context, this paper examines the usage patterns of CS delivery and estimates the share of public health subsidies on CS deliveries among mothers by different background characteristics in India. DATA Data from the fourth round of the National Family Health Survey (NFHS-4) was used for the study. Out-of-pocket (OOP) payment for CS delivery was used as a dependent variable and was analyzed by level of care that is, primary (PHC, UHC, other) and secondary (government/municipal, rural hospital). Descriptive statistics, binary logistic regression, benefit incidence analysis, concentration curve and concentration index were used for the analysis. RESULTS A strong economic gradient was observed in the utilization of CS delivery from public health facilities. Among mothers using any public health facility, 23% from the richest quintile did not pay for CS delivery compared to 13% from the poorest quintile. The use of the public subsidy among mothers using any type of public health facility for CS delivery was pro-rich in nature; 9% in the poorest quintile, 16.1% in the poorer, 24.5% in the middle, 27.5% among richer and 23% in the richest quintile. The pattern of utilization and distribution of public subsidy was similar across the primary and secondary health facilities but the magnitude varied. The findings from the benefit-incidence analysis are supported by those obtained from the inequality analysis. The concentration index of CS was 0.124 for public health centers and 0.291 for private health centers. The extent of inequality in the use of CS delivery in public health centers was highest in the state of Mizoram (0.436), followed by Assam (0.336), and the lowest in Tamil Nadu (0.060), followed by Kerala (0.066). CONCLUSION The utilization of CS services from public health centers in India is pro-rich. Periodically monitoring and evaluating of the cash incentive schemes for CS delivery and generating awareness among the poor would increase the use of CS delivery services in public health centers and reduce the inequality in CS delivery in India.
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Affiliation(s)
| | - Suyash Mishra
- International Institute for Population Sciences, Mumbai, India
| | - Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India
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Sk MIK, Ali B, Biswas MM, Saha MK. Disparities in three critical maternal health indicators amongst Muslims: Vis-a-vis the results reflected on National Health Mission. BMC Public Health 2022; 22:266. [PMID: 35139830 PMCID: PMC8830117 DOI: 10.1186/s12889-022-12662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background The post national health mission era has been recognized for India’s accelerating improvement in maternal health care utilization. Concurrent investigations with the purview of examining inequalities in maternal care utilisation have rigorously examined across various socio-economic groups, focusing on Muslim women. The present study examined socio-economic differentials in maternal health care utilisation among Muslims and the delineated factors which are contributing for these inequalities. Methods Study used the data from National Family Health Survey (NFHS) conducted in 2005-06 and 2015-16. the present study applied concentration index and Wagstaff-type decomposition analysis to measure and decompose the inequality in maternal health services. Results This study found that utilisation of full antenatal care (full ANC), skilled attendants at birth (SBAs) and postnatal care was increased during 2005-06 to 2015-16. However, the least improvement was observed in full antenatal care whereas substantial improvement was achieved in utilising skilled attendants at birth. Further, the poor and non-poor gap in maternal health care utilisation mostly prevailed among the educated, urban resident, other backward castes among Muslims. The inequality has been declined largely in SBA utilisation compared to full ANC and PNC, especially in the southern India. Higher education, mass media exposure, higher birth order and urban residence contribute and explain most of these inequalities in maternal care among Muslim women Conclusions Despite the fact that free and cash benefitted health programmes, wealth, mass media exposure and education etc welfare programs benefitted a large number of citizens, it also produced most of the inequalities among Muslims in India. The results focus on the significance of wealth, education, and mass media exposure in bridging the socioeconomic gap in maternal health care utilization among Muslims.
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Affiliation(s)
| | - Balhasan Ali
- International Institute for Population Sciences, Mumbai, India.
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Singh A, Palaniyandi S, Palaniyandi A, Gupta V, Panika RK, Mahore RK, Goel PK. A cross-sectional study to assess the utilization pattern of maternal health services and associated factors in aspirational district of Haryana, India. J Family Med Prim Care 2021; 10:2879-2885. [PMID: 34660420 PMCID: PMC8483117 DOI: 10.4103/jfmpc.jfmpc_1762_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/27/2020] [Accepted: 06/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background: In India mother related mortalities and morbidities are still significantly higher even after having various maternal program and schemes at regional and national level which reflects that such services are being under-utilized. Aim: The current study focused in assessing utilization pattern of maternal health services and associated factors in Nuh (Mewat). Methods: This present cross-sectional study was done for one year (2015-16) among mothers (15-49 years) under field practice area, PHC Taoru with minimum calculated sample as 645. The selection of participants was made using simple random sampling technique from available randomized list of villages. Data was collected by home-to-home visits using pretested, predesigned, standardized questionnaire and during analysis an association between variables was considered as significant if P < 0.05. Results: Out of 645 participants, 632 provided consent for inclusion into study. Any ANC and full ANC services was made by only 58.3% and 11.7% of participants respectively. More than half of the participants (52.7%) had suffered from pregnancy related complications. Variables such as lower age group, low decision-making capacity were significantly associated with not obtaining full ANC services (P < 0.05). Conclusion: In the present study major determinants of a women which influence utilization of maternal health care service includes their age, literacy status, parity, socioeconomic status and occupation. Such determinants shall be considered for upcoming intervention aiming to bring attitudinal changes and concurrently leading to improved and enhanced usage of maternal health care services.
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Affiliation(s)
- Abhishek Singh
- Department of Community Medicine, SHKM Government Medical College, Nalhar, Haryana, India
| | - Subramani Palaniyandi
- Department of Pediatric Medicine, Tagore Medical College, Rathinamangalam, Chennai, Tamil Nadu, India
| | - Anitha Palaniyandi
- Department of Pediatric Medicine, Sri Ramachandra Medical College, Porur, Chennai, Tamilnadu, India
| | - Vikas Gupta
- Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India
| | - Ram Kumar Panika
- Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India
| | - Rakesh Kumar Mahore
- Department of Community Medicine, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
| | - Pawan Kumar Goel
- Department of Community Medicine, SHKM Government Medical College, Nalhar, Haryana, India
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Patel R, Marbaniang SP, Srivastava S, Kumar P, Chauhan S. Why women choose to deliver at home in India: a study of prevalence, factors, and socio-economic inequality. BMC Public Health 2021; 21:1785. [PMID: 34600528 PMCID: PMC8487549 DOI: 10.1186/s12889-021-11779-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To promote institutional delivery, the Government of India, through the Janani Suraksha Yojana (JSY) program, gives monetary reward to all pregnant women who give birth at the government or private health center. Despite providing cash assistance, a higher number of women are still preferring delivering at home. Therefore, this study sought to determine the prevalence of home births and identifying the factors influencing women's choice of home deliveries. METHODS Data from the National Family Health Survey (NFHS) conducted during 2005-06 and 2015-16 were used in the study. The respondents were women 15-49 years; a sample of 36,850 and 190,898 women in 2005-06 and 2015-16 respectively were included in the study. Multivariate logistic regression was used to determine the factors influencing home delivery. Income-related inequality in home delivery was quantified by the concentration index (CI) and the concentration curve (CC), and decomposition analysis was used to examine the inequality in the prevalence of home deliveries. RESULTS The prevalence of home deliveries has reduced from 58.5% in 2005-06 to 18.9% in 2015-16. The odds of delivering babies at home were lower among women who had full ANC in 2005-06 [AOR: 0.34; CI: 0.28-0.41] and in 2015-16 [AOR: 0.41; CI: 0.38-0.45] and were higher among women with four or higher parity in 2005-06 [AOR: 1.70; CI: 1.49-1.92] and in 2015-19 [AOR: 2.16; CI: 2.03-2.30]. Furthermore, the odds of delivering babies at home were higher among rural women and were lower among women with higher education. It was found that the value of CI increased from - 0.25 to - 0.39 from 2005-06 to 2015-16; this depicts that women delivering babies at home got more concentrated among women from lower socio-economic status. CONCLUSION There is a need to promote institutional deliveries, particular focus to be given to poor women, women with higher parity, uneducated women, and rural women. ANC is the most concurring contact point for mothers to get relevant information about the risks and complications they may encounter during delivery. Therefore, effort should be directed to provide full ANC. Targeted interventions are called for to bring improvements in rural areas.
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Affiliation(s)
- Ratna Patel
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Strong P Marbaniang
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Pradeep Kumar
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India.
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Mustafa A, Shekhar C. Contrast in utilization of maternal and child health services between Himalayan region and rest of India: Evidence from National Family Health Survey (2015-16). BMC Pregnancy Childbirth 2021; 21:606. [PMID: 34482825 PMCID: PMC8419927 DOI: 10.1186/s12884-021-04081-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 08/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Maternal and child health services, like antenatal care, skilled birth attendance and postnatal care, are crucial to improve maternal and neonatal health outcomes. Numerous studies have been conducted on the distribution of utilization of maternal and child healthcare (MCH) services in India with respect to socioeconomic and demographic characteristics. But no study has analyzed the utilization of MCH services with a focus on the topography of a given region (hilly/plain). The present study analyzes the utilization of MCH services in the hilly-Himalayan region of India in comparison to the rest of the country. Methods Data from India’s National Family Health Survey-4 (2015–16), on 190,898 women, was utilized for analysis in the present study. The association between the utilization of MCH services and the topography of the region of residence (hilly/plain) was analyzed by calculating adjusted odds ratios (AOR) with 95% confidence interval (95%CI) and predicted probabilities using a two-level random intercept logistic regression model. Results It was found that the utilization of MCH services was significantly lower in the hilly regions compared to the plain regions. Women living in hilly areas (AOR: 0.42, 95%CI: 0.39–0.45) had 58% lower odds of receiving skilled birth attendance (SBA) than those living in plain areas. Similarly, the odds of receiving PNC, ANC, and full immunization were also lower in the hilly regions compared to the plain regions. The utilization of MCH services was alarmingly low in the rural-hilly regions. The odds of receiving two tetanus injections before birth were 71% lower for women in the rural-hilly areas (AOR: 0.39, 95% CI: 0.36–43) than those in the rural-plain areas. Predicted probabilities also showed that women in the hilly regions were less likely to receive MCH services compared to their counterparts in the plain regions. Conclusion Except for the consumption of Iron Folic Acid (IFA) and the utilization of AWC services/ICDS (Integrated Child and Development Services), all other MCH services were significantly underutilized in the hilly regions compared to the plain regions. This calls for the attention of and concentrated efforts by policy makers and stakeholders, with a special focus on the rural-hilly regions. We firmly believe that the results of the present study have important policy implications. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04081-0.
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Affiliation(s)
- Akif Mustafa
- Research Fellow, International Institute for Population Sciences (IIPS), Mumbai, 400088, India.
| | - Chander Shekhar
- Department of Fertility Studies, International Institute for Population Sciences (IIPS), Mumbai, India
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Mondal NA, Ali B, Kanchan Sk MI. Has Muslim Got Benefited from the National Health Mission? A Situational Analysis of Maternal Health Services in India. Ethiop J Health Sci 2021; 30:785-794. [PMID: 33911841 PMCID: PMC8047265 DOI: 10.4314/ejhs.v30i5.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background It is a marked recognition that when the population is disaggregated by religion, wide disparities in the utilization of maternal health care services can be observed. The study was aimed to analyze the levels and trends of maternal health services among Muslims in India. The study also delineated the investigation of confounding factors attributed to maternal health services among the selected population. Methods The study utilized the data from the third and fourth round of National Family Health Survey (NFHS), conducted in 2005–06 and 2015–16 respectively. The bivariate and multivariate logistic regression models were employed to accomplish the study objectives. Result There is an increasing trend in the distributional patterns of all three indicators (full ANC, SBA and PNC) during the last two successive surveys. Muslim women belonging to Southern States were seen to be utilizing more maternal health care services as compared to Muslim women in the Northern States. Muslim populated States like Assam, Bihar, Jharkhand, Uttar Pradesh and West Bengal were far cry to achieve the MDG-15 target of utilization of 100 percent skilled birth attendants in 2015. Education, media exposure and wealth status appeared to be major confounding factors for determining the utilization of maternal health services. Conclusion The study revealed that the utilizations of maternal health services among Muslims have progressed during the last decade. It can be concluded that the NHM policy has played an instrumental role in increasing the utilization of maternal health services among Muslims.
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Affiliation(s)
- Nasim Ahamed Mondal
- Statistician, National Institute for Research in Reproductive Health, ICMR, Mumbai, India
| | - Balhasan Ali
- Doctoral Fellow, International Institute for Population Sciences, Mumbai, India
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Dewau R, Angaw DA, Kassa GM, Dagnew B, Yeshaw Y, Muche A, Feleke DG, Molla E, Yehuala ED, Tadesse SE, Yalew M, Fentaw Z, Asfaw AH, Andargie A, Chanie MG, Ayele WM, Hassen AM, Damtie Y, Hussein FM, Asfaw ZA, Addisu E, Adane B, Ayele FY, Kefale B, Zerga AA, Mekonnen TC, Necho M, Ebrahim OA, Adane M, Ayele TA. Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis. PLoS One 2021; 16:e0255094. [PMID: 34329310 PMCID: PMC8323938 DOI: 10.1371/journal.pone.0255094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 07/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. METHODS The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). RESULTS The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. CONCLUSIONS The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women's income, access to health care facilities to increase the frequency of antenatal care utilization.
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Affiliation(s)
- Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Dejen Getaneh Feleke
- Department of Neonatal Nursing, College of Medicine and Health Sciences, Debretabor University, Debretabor, Ethiopia
| | - Eshetie Molla
- Department of Public Health, College of Medicine and Health Sciences, Debretabor University, Debretabor, Ethiopia
| | - Enyew Dagnew Yehuala
- Department of Midwifery College of Medicine and Health Sciences, Debretabor University, Debretabor, Ethiopia
| | - Sisay Eshete Tadesse
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zinabu Fentaw
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ahmed Hussien Asfaw
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Assefa Andargie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Muluken Genetu Chanie
- Department of Health System and Policy, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wolde Melese Ayele
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Anissa Mohammed Hassen
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Foziya Mohammed Hussein
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zinet Abegaz Asfaw
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Elsabeth Addisu
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fanos Yeshanew Ayele
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aregash Abebayehu Zerga
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tefera Chane Mekonnen
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kumar P, Srivastava S, Maurya C, Dhillon P. An assessment of the role of socio-economic, maternal and service utilization factors in increasing self-reported maternal complications in India. BMC Pregnancy Childbirth 2021; 21:519. [PMID: 34289804 PMCID: PMC8296634 DOI: 10.1186/s12884-021-03997-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Self-reported maternal complications are associated with maternal morbidity, deliveries by C-section, postpartum depression, and maternal death. Thus, it is necessary to examine the contribution of socio-demographic and maternal characteristics, as well as service utilization in the rising self-reporting of maternal complications (difficulty with daylight vision, convulsions, swelling of the legs, body or face, heavy vaginal bleeding or high fever) in India. The study aimed at examining the factors that have influenced the increasing prevalence of maternal complications between 2005–06 and 2015–16 in India. Methods Data from the two most recent rounds of the National Family Health Survey, which covered a sample of 36,850 and 190,898 women respectively who delivered in the last five years preceding the survey has been used. Logistic regression analysis was performed to carve out the factors which significantly contributed to maternal complications among women aged 15 – 49 years in India. With the help of the Fairlie decomposition technique, the study quantified the contribution of factors which influenced the changes in maternal complications in the period from 2005–06 to 2015–16. Results A significant increase was seen in the prevalence of maternal complications — from 43.6% to 53.7% between the years 2005–06 and 2015–16. About 21% of the increase could be explained by certain maternal, households level factors, service utilization and birth outcomes. For example, service utilization, in which 13% was attributed to the place of delivery and 6% to postnatal care, was the major contributor to the increase in maternal complications from 2005–06 to 2015–16). This was followed by individual-level factors like education (2%), body mass index (4%) and tobacco use,. It was also found that household-level factors like standard of living (-3.7%) and region (-1.4%), and birth weight contributed to the reduction of complications during the period. Conclusion The increase in the prevalence of maternal complications in India could be attributed mainly attributed to increase in reporting behavior, an outcome of increased utilization of maternal healthcare services, and increase in BMI. However, reduced prevalence of maternal complications can be attributed to the decrease in the prevalence of low-birth-weight babies and tobacco use among women in India. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03997-x.
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Affiliation(s)
- Pradeep Kumar
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shobhit Srivastava
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Chanda Maurya
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Preeti Dhillon
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, India.
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Ali B, Debnath P, Anwar T. Inequalities in utilisation of maternal health services in urban India: Evidences from national family health survey-4. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kumar P, Patel R, Chauhan S, Srivastava S, Khare A, Kumar Patel K. Does socio-economic inequality in infant mortality still exists in India? An analysis based on National Family Health Survey 2005–06 and 2015–16. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mohanty SK, Mishra RS, Mishra S, Sen S. Understanding equity of institutional delivery in public health centre by level of care in India: an assessment using benefit incidence analysis. Int J Equity Health 2020; 19:217. [PMID: 33298077 PMCID: PMC7724812 DOI: 10.1186/s12939-020-01331-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The National Health Mission (NHM), the largest ever publicly funded health programme worldwide, used over half of the national health budget in India and primarily aimed to improve maternal and child health in the country. Though large scale public health investment has improved the health care utilization and health outcomes across states and socio-economic groups in India, little is known on the equity concern of NHM. In this context, this paper examines the utilization pattern and net benefit of public subsidy for institutional delivery by the level of care in India. METHODS Data from the most recent round of the National Family Health Survey (NFHS 4), conducted during 2015-16, was used in the study. A total of 148,645 last birth delivered in a health centre during the 5 years preceding the survey were used for the analyses. Out-of-pocket (OOP) payment on delivery care was taken as the dependent variable and was analysed by primary care and secondary level of care. Benefits Incidence Analysis (BIA), descriptive statistics, concentration index (CI), and concentration curve (CC) were used to do the analysis. RESULTS Institutional delivery from the public health centres in India is pro-poor and has a strong economic gradient. However, about 28% mothers from richest wealth quintile did not pay for delivery in public health centres compared to 16% among the poorest wealth quintile. Benefit incidence analyses suggests a pro-poor distribution of institutional delivery both at primary and secondary level of care. In 2015-16, at the primary level, about 32.29% of subsidies were used by the poorest, 27.22% by poorer, 20.39% by middle, 13.36% by richer and 6.73% by the richest wealth quintile. The pattern at the secondary level was similar, though the magnitude was lower. The concentration index of institutional delivery in public health centres was - 0.161 [95% CI, - 0.158, - 0.165] compared to 0.296 [95% CI, 0.289, 0.303] from private health centres. CONCLUSION Provision and use of public subsidy for institutional delivery in public health centres is pro-poor in India. Improving the quality of service in primary health centres is recommended to increase utilisation and reduce OOP payment for health care in India.
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Affiliation(s)
- Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India.
| | - Radhe Shyam Mishra
- Research Scholar, International Institute for Population Sciences, Mumbai, India
| | - Suyash Mishra
- Research Scholar, International Institute for Population Sciences, Mumbai, India
| | - Soumendu Sen
- Research Scholar, International Institute for Population Sciences, Mumbai, India
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Paul PL, Pandey S. Factors influencing institutional delivery and the role of accredited social health activist (ASHA): a secondary analysis of India human development survey 2012. BMC Pregnancy Childbirth 2020; 20:445. [PMID: 32758171 PMCID: PMC7405437 DOI: 10.1186/s12884-020-03127-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background India has focused on incentivizing institutional delivery and introducing the ASHA worker as a key strategy to improve maternal health outcomes. We examined the determinants of institutional delivery and the role of the ASHA worker in shaping choice regarding place of delivery. Methods We used data from the India Human Development Survey-II conducted in 2011–12, and extracted an analytic sample of women (N = 8711) who reported having at least one child since 2005. Logistic regression was used to examine influence of socio-demographic factors, frequency of antenatal care (ANC) contacts and exposure to ASHA worker on institutional delivery. Results About 15% of the respondents had eight or more ANC contacts. The odds of having an institutional delivery were higher among those respondents who had 8 or more ANC contacts (OR = 3.39, p < 0.001, 95% CI: 2.26, 5.08), and those who had 4–7 ANC contacts (OR = 1.72, p < 0.001, 95% CI: 1.48, 1.99) as compared to those with less than 4 ANC contacts. About 26% of the respondents had any exposure to an ASHA worker. After controlling for ANC contacts, these respondents had three times the odds of institutional delivery (OR = 3.04, p < 0.001, 95% CI: 2.37, 3.89) compared to those who had no exposure to ASHA workers. Further, several sociodemographic variables were associated with institutional delivery. While age of spouse, age at marriage, level of education and urban residence were positively associated with institutional delivery; age of respondent and number of children were inversely associated with institutional delivery. Conclusions Both frequency of ANC contacts and exposure to ASHA worker independently emerge as important determinants of institutional delivery. Furthermore, ASHA workers may have a crucial role in promoting antenatal care, thereby strengthening the association between ANC contacts and institutional delivery.
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Affiliation(s)
- Pooja L Paul
- Boston College, School of Social Work, McGuinn Hall 204, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Shanta Pandey
- Boston College, School of Social Work, McGuinn Hall 204, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
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Ghosh A, Ghosh R. Maternal health care in India: A reflection of 10 years of National Health Mission on the Indian maternal health scenario. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 25:100530. [PMID: 32434138 DOI: 10.1016/j.srhc.2020.100530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/27/2019] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Maternal healthcare coverage is the outcome of health service availability and utilization, and includes antenatal care (ANC), care at delivery, and postnatal care. This study examines the contribution of India's National Health Mission (NHM) to maternal health through a pre-post comparison of rates of delivery at a healthcare institution and use of ANC along with inequalities in the determinants of one of the major maternal health outcomes-at least four ANC visits. METHODS Data came from the Indian National Family Health Surveys conducted between 1992-93 and 2015-16. A multivariate logistic regression model was used to estimate the odds ratios (ORs) associated with the predictors of at least four ANC visits. RESULTS Institutional delivery increased by 12.6 percentage points between 1992-93 and 2005-06 (the pre-NRHM era), and thereafter interventions through the National Rural Health Mission/NHM contributed to a significant increase of 40.2 percentage points from 2005-06 to 2015-16. However, both inter- and intra-state disparities persist even now. Overall, the proportion of pregnant women who have at least four ANC visits is as low as 51.2 percent. The likelihood of having at least four ANC visits is almost four times higher for women in the richest households compared with those in the poorest (OR: 3.59; 95% CI: 3.44-3.75) CONCLUSION: Future public health efforts should focus on removing inter- and intra-state disparities in institutional delivery and ensuring at least four ANC visits for pregnant women, to meet the infant and maternal mortality targets set out in the Sustainable Development Goals (SDG).
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Affiliation(s)
- Arabinda Ghosh
- OSD & Ex-Officio Additional Secretary, Government of West Bengal, India.
| | - Rohini Ghosh
- Medical College and Hospital, Kolkata, West Bengal, India
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