Multiple Deprivations and Maternal Care in India

Abstract

Despite concerted efforts by national and local governments, and by nongovernmental and international organizations, the utilization of maternal health services in developing countries is far from universal and varies strongly within and between countries.1 Moreover, income disparity in access to maternal care is widening across and within countries, with poor women receiving fewer services than those who are better off. 2-5 Antenatal visits have multiple benefits-early detection of pregnancy complications, anemia and related health problems, as well as an increased chance of further health care utilization and contraceptive use-and delivery at a health center significantly reduces maternal and infant deaths. 6-9For these reasons, universal access to sexual and reproductive health was integrated as one of the key targets of the MDGs in 2006. India's progress toward universal access to sexual and reproductive health is of global significance, as India accounts for 17% of the world's population and more than one-fifth of all maternal and child deaths.10,11 Empirical evidence suggests that maternal care has improved in India over the last two decades, but progress has been slow overall and uneven within the country. For example, the proportions of women in India who received at least three antenatal visits for their last pregnancy and medical assistance at delivery increased between 1992 and 2006, from 44% to 51% and from 35% to 49%, respectively; 12 however, the rich-poor ratio (i.e., the ratio of the richest to the poorest wealth quintile) for use of antenatal care remained at 3.3 over the period, while the ratio for use of medical assistance at delivery declined from 5.1 to 4. and 2006 that were delivered in a heath center varied from 18% for women with no education to 86% for those with 12 or more years of schooling. 12In the last two decades, research has contributed to the understanding of economic disparities in health and health care utilization. Many studies used data from Demographic and Health Surveys (DHS) and analyzed inequalities in maternal and child health by household wealth, controlling for other social and demographic confounders. [13][14][15][16][17][18] In addition, some outlined the contextual determinants of maternal and child care in different Indian states. 19-22Although such research has demonstrated that household wealth plays a key role in health inequality, little attention has been paid to understanding the linkages between multiple dimensions of deprivation and health care utilization.

Childbearing traditions of Indian women at home and abroad: An integrative literature review

“…The 12 articles from India were all original research articles and eight were carried out predominantly among rural populations, 10-17 two related to urban settings 18,19 and two analysed national data. 20,21 This high proportion of studies on the rural population might be related to the facts that in India 74% of the population resides in rural areas and 70% of rural births are at home, assisted by family members or traditional birth helpers. With one exception, 17 all 12 articles mention, if not focus on, the high maternal and neonatal mortality rates in India.…”

“…22 Alongside this diversity, significant disparities in maternal and infant health exist depending on the person's class, place of residence, wealth and education. 10,18,[20][21][22]37 To evaluate the outcomes of caseload midwifery practice in a socially deprived and ethnically diverse inner-city area India is one of 189 countries committed to the Millennium Development Goal of reducing maternal and neonatal mortality rates by 75% during the period 1990-2015. 10,29 Since 2005, the Indian government has sponsored a cash-incentive scheme to poor and marginalised women to encourage them to give birth in an institution and receive antenatal and postnatal care.…”

“…However, its level of implementation varies widely among the states. 10,20,21 Women in rural areas access healthcare less than those in urban areas. 10 The subjects of a study in rural Rajasthan attributed their reluctance to give birth at a facility to it being an unfamiliar place staffed by nurses and doctors who, unlike the village dai (birth helper), were not known to them.…”

An intersectional approach for understanding the vulnerabilities of English-speaking heterosexual Caribbean youth to HIV/AIDS and sexually transmitted infections: Prevention and intervention strategies

“…However, the limited data from the Caribbean indicate that youth who grow up in structured households with consistent rules and regulations and with supportive and nurturing parents are less likely to engage in risky sexual behaviors (Ishida, 2011). In contrast, unhealthy family dynamics, such as parent–child conflicts, parents’ substance abuse, parents’ first sexual experience being at an early age, low parental supervision and monitoring of adolescents, and an authoritarian parenting style that relies on physical punishment of children are related to risky sexual behaviors (Ishida, 2011).…”

Dynamic Relationships Between Parental Monitoring, Peer Risk Involvement and Sexual Risk Behavior Among Bahamian Mid-Adolescents

“…14,15 According to a comprehensive health survey conducted by the World Health Organization among 16,000 youth aged 10–18 in nine Caribbean nations, more than 50% of sexually active males and 25% of sexually active females reported having had their first sexual experience by age 10, and only 53% of males and females had used a condom at last sex. 16 A survey among Jamaican 15–19-year-olds found that 54% of males and 32% of females had had sexual intercourse in the past year; 15 of those, 52% of males and 12% of females had had more than one sexual partner during that period.…”