Pathways of Economic Inequalities in Maternal and Child Health in Urban India: A Decomposition Analysis

Goli, Srinivas; Doshi, Riddhi; Arokiasamy, Perianayagam

doi:10.1371/journal.pone.0058573

Cited by 75 publications

(65 citation statements)

References 23 publications

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“…The results of the decomposition analysis of inequalities in child malnutrition highlight poor economic status and mother's illiteracy followed by rural areas as the major significant contributors for nutritional deficiency among children across the three rounds of NFHS. Our findings are consistent with several other studies that have shown poverty and parental education explained more than 50 and 25 percent of inequality in malnutrition, respectively (Pathak and Singh, 2011;Goli et al, 2013). Poverty is a complex phenomenon which ramifies through various channels.…”

Section: Discussionsupporting

confidence: 93%

“…Furthermore, the socioeconomic 644 IJSE 43,6 inequalities are the result of an unequal distribution of resources (Woodward and Kawachi, 2000;Wagstaff and Watanabe, 2000;Wagstaff, 2002a, b). Such avoidable inequalities are, therefore, considered as unjust (Houweling et al, 2003;Carr, 2004;Gwatkin et al, 2004) and hence, assumed as an inhibitor in achieving the Millennium Development Goals (MDGs) [2] in India, particularly MDGs one (eradicate extreme poverty and hunger), four (reduce child mortality) and five (improve maternal health) (Subramanian and Smith, 2006;Mohanty and Pathak, 2009;Goli et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Inequalities among malnourished children in India

Prakash

Jain

2016

International Journal of Social Economics

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If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -The purpose of this paper is threefold: first, to measure the health inequalities among malnourished children; second, to decompose the health inequalities to identify key socioeconomic predictors for child malnutrition; and third, to assess the change in the proportional contribution of key predictors over time. Design/methodology/approach -The study has used data . The information on anthropometric indicators for children below three years of age is provided; however the study is restricted to "weightfor-age," as it is considered to be a comprehensive indicator of child nutritional status. In the first stage of analysis, health inequalities are measured among malnourished children using concentration indices (CI) for each round of NFHS. In second stage, the inequalities are decomposed to estimate the proportional contribution of socioeconomic predictors. In the third stage, change in the relative contribution of socioeconomic predictors over three rounds is assessed to suggest target-specific policies and programs. Findings -The results highlight a slow decline of only seven percentage points in the proportion of malnourished children in India during 1992-2006. The increasing values of CIs from −0.13 (1992) to −0.18 (2006) demonstrates the concomitant rise in economic inequalities among malnourished children.The results of decomposition analysis point toward household poor economic status and mother's illiteracy as the major contributor of inequalities during 1992-2006. During the study period, the economic status explained 50, 65 and 59 percent of inequalities, whereas mother's illiteracy explained 40, 30 and 29 percent of inequalities, respectively. Overall, the contributors to health inequalities remained the same over time with a change in their relative contribution.Research limitations/implications -The present study is focussed on three rounds of NFHS data conducted at different time period and so it has certain limitations which should be kept in mind while interpreting the results. The study has revealed mother's education and economic status of the household as the major contributory factors toward child health inequalities. However, one should not forget t...

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Inequalities among malnourished children in India

Prakash

Jain

2016

International Journal of Social Economics

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“…The contribution of illiteracy and poverty to inequality in institutional deliveries were reported by an Indian study conducted prior to the JSY, though this study reported an effect of literacy among women and men (Goli et al, 2013). Experience from neighbouring Bangladesh also suggest that although a demand side financing program raised the utilization of maternal health services in poor population groups, a pro-rich slant in utilization persisted which indicates that a demand-side financing program alone is not a sufficient measure (Ahmed and Khan, 2011).…”

Section: Inequality In Institutional Deliveries and Emocmentioning

confidence: 72%

Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: Results from nine states in India

Randive

Sebastián

Costa

et al. 2014

Social Science & Medicine

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Proportion of women giving birth in health institutions has increased sharply in India since the introduction of cash incentive program, Janani Suraksha Yojana (JSY) in 2005. JSY was intended to benefit disadvantaged population who had poor access to institutional care for childbirth and who bore the brunt of maternal deaths. Increase in institutional deliveries following the implementation of JSY needs to be analysed from an equity perspective. We analysed data from nine Indian states to examine the change in socioeconomic inequality in institutional deliveries five years after the implementation of JSY using the concentration curve and concentration index (CI). The CI was then decomposed in order to understand pathways through which observed inequalities occurred. Disparities in access to emergency obstetric care (EmOC) and in maternal mortality reduction among different socioeconomic groups were also assessed. Slope and relative index of inequality were used to estimate absolute and relative inequalities in maternal mortality ratio (MMR). Results shows that although inequality in access to institutional delivery care persists, it has reduced since the introduction of JSY. Nearly 70% of the present inequality was explained by differences in male literacy, EmOC availability in public facilities and poverty. EmOC in public facilities was grossly unavailable. Compared to richest division in nine states, poorest division has 135 more maternal deaths per 100,000 live births in 2010. While MMR has decreased in all areas since JSY, it has declined four times faster in richest areas compared to the poorest, resulting in increased inequalities. These findings suggest that in order for the cash incentive to succeed in reducing the inequalities in maternal health outcomes, it needs to be supported by the provision of quality health care services including EmOC. Improved targeting of disadvantaged populations for the cash incentive program could be considered.

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“…Illiteracy was the key predictor for a number of antenatal care check-ups, institutional delivery, child immunization and infant deaths while low socioeconomic status was the key predictor for underweight children. This study shows a relationship between socioeconomic status and access to and utilization of care in urban populations in India (Goli, Doshi & Perianayagam, 2013).…”

Section: Hiv/aidsmentioning

confidence: 71%

The Global and Local Factors Influencing Maternal Mortality Ratios: Barriers and Recommendations for Success

DiOrio¹,

Crivelli-Kovach²

2014

JSSPI

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__________________________________________________________________Maternal death is defined as the death of a female of reproductive age during pregnancy, labor or within 42 days of termination of pregnancy from causes that are related to or aggravated by pregnancy and relevant care. Maternal deaths are measured by maternal mortality ratios per country and are reported as the number of maternal deaths per 100,000 live births. Each year an estimated 500,000 women die worldwide from complications due to pregnancy or labor and about half of these women live in Sub-Saharan Africa. The rationale for conducting this study is to address the prevalent and preventable issue, maternal death and to assess barriers to the achievement of the 5 th Millennium Development Goal. Purpose: To explore maternal mortality worldwide and in Sub-Saharan Africa, to analyze health risk factors, social/environmental factors, tracking techniques, intervention techniques and policy factors both worldwide and in Sub-Saharan Africa and make recommendations for Sub-Saharan Africa aimed at reducing maternal mortality rates and achieving the 5 th Millennium Development Goal. Methods:The design is a comparative literature review and policy analysis. Variables were chosen based on their relation to the outcome, maternal health. Studies reviewed came from peer-reviewed journals found in Arcadia University's Landman Library. Key words and phrases were used to identify relevant articles. Relevant data was extracted from articles such as demographic information, sample size, intervention being tested or chronic condition being observed and impact on the outcome, maternal health. Recommendations were then made for improving the likelihood of success for the Millennium Development Goal 5. Policy Analysis: An assessment of policies implemented in Sub-Saharan Africa indicated that previous declarations and initiatives have failed within the last 40 years due to lack of funding and enforcement, resource scarcity, lack of government involvement and corruption. A lack of resources has created barriers to access for all of the population, in particular women who face gender inequality and discrimination. Lack of resources, enforcement and funding increase the disease burden and decrease access to care in Sub-Saharan Africa. A lack of education and gender inequality adds additional barriers for women and girls that ultimately influences maternal mortality rates in these countries. Recommendations: Using the Africa Health Strategy: 2007-2015 as a model, policy reform is necessary with elements of female empowerment through education and access to health care including control over social aspects of their lives such as marriage, family planning and cultural rituals such as female genital mutilation. The policy must be comprehensive and have a strong regulation and accountability system so that when decisions are made in the government, they are enforced at the community level. Lastly, communication is vital to policy reform; the system must have effectiv...

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Pathways of Economic Inequalities in Maternal and Child Health in Urban India: A Decomposition Analysis

Cited by 75 publications

References 23 publications

Inequalities among malnourished children in India

Inequalities among malnourished children in India

Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: Results from nine states in India

The Global and Local Factors Influencing Maternal Mortality Ratios: Barriers and Recommendations for Success

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