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Inequality in the Utilisation of Maternal Healthcare Services
How the pattern of inequality in maternal healthcare service utilisation has evolved after the adoption of the National Rural Health Mission in 2005 is analysed here and the absolute as well as relative measures of inequality at the state level are estimated. National Family Health Survey data from the third round (2006) and the fourth round (2016) shows that inequality has declined but poor women in poor states still have a long way to go to catch up with even the poor in rich states. By 2016, 10 years after the implementation of the NRHM, the utilisation of maternal healthcare services by poor women in well-performing states was higher than the utilisation of similar services by rich women in poorly performing states.
This work was supported by the MacArthur Foundation (G-109245-0) under the aegis of “policy research and advocacy for strategic investment in maternal, newborn and child health in India.” The author is thankful to K G Santhya, T V Sekher, and the anonymous referee for their insightful comments.
A high maternal mortality rate, along with persistent inequality in maternal healthcare service utilisation and maternal health outcomes, is a serious concern in India. Although there has been a significant decline in the maternal death rate in recent years, India still accounts for one-fifth of global maternal deaths annually (WHO 2015). In this paper, the objective is to study how maternal healthcare services coverage has improved while inequality in maternal healthcare utilisation has declined across 29 states in India after the implementation of the National Rural Health Mission (NRHM) in 2005.
The Indian government launched the NRHM in 2005 to eradicate persistent inequalities by providing good quality and affordable healthcare services to all, especially to the socio-economically weaker sections of society (MoHFW 2005). One of the important components of the NRHM is a conditional cash transfer programme—the Janani Suraksha Yojana (JSY)—to provide financial support to poor women to enable them to give birth in healthcare facilities (Lim et al 2010). The programme provided financial support to all women undergoing institutional deliveries in 18 states with poor maternal and child health indicators and to poor women alone in the remaining 10 states. The high-focus states were Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Odisha, Rajasthan, Sikkim, Tripura, Uttarakhand, and Uttar Pradesh.
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