Socio-Economic Inequalities in the Use of Postnatal Care in India

Abstract

ObjectivesFirst, our objective was to estimate socio-economic inequalities in the use of postnatal care (PNC) compared with those in the use of care at birth and antenatal care. Second, we wanted to compare inequalities in the use of PNC between facility births and home births and to determine inequalities in the use of PNC among mothers with high-risk births.Methods and FindingsRich–poor ratios and concentration indices for maternity care were estimated using the third round of the District Level Household Survey conducted in India in 2007–08. Binary logistic regression models were used to examine the socio-economic inequalities associated with use of PNC after adjusting for relevant socio-economic and demographic characteristics. PNC for both mothers and newborns was substantially lower than the care received during pregnancy and child birth. Only 44% of mothers in India at the time of survey received any care within 48 hours after birth. Likewise, only 45% of newborns received check-up within 24 hours of birth. Mothers who had home births were significantly less likely to have received PNC than those who had facility births, with significant differences across the socio-economic strata. Moreover, the rich-poor gap in PNC use was significantly wider for mothers with birth complications.ConclusionsPNC use has been unacceptably low in India given the risks of mortality for mothers and babies shortly after birth. However, there is evidence to suggest that effective use of pregnancy and childbirth care in health facilities led to better PNC. There are also significant socio-economic inequalities in access to PNC even for those accessing facility-based care. The coverage of essential PNC is inadequate, especially for mothers from economically disadvantaged households. The findings suggest the need for strengthening PNC services to keep pace with advances in coverage for care at birth and prenatal services in India through targeted policy interventions.

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.…”

“…A UK study 27 examined the effect of caseload midwifery practices on a culturally diverse group and one Australian study 4 compared the obstetric intervention rates and birth outcomes between Australian and overseas born. Also included in the review were ten literature reviews 6,7,[27][28][29][30][31][32][33][34] (Table 3), one book chapter, 22 and three scholarly, but non-research articles; a clinical paper on the Migrant Health Guide in UK, 35 a report from the Lancet 36 and To explore the links between multiple deprivations and use of maternal services 21 Singh an opinion piece in Australian Midwifery News by an Indian midwife. 37 No research article was found specifically exploring Indian women's childbearing experiences in Australia.…”

Public Spending on Health and Childhood Mortality in India

“…There are numerous evidence from India that show that the public health system in India treats its clients according to their socio-economic conditions (Singh et al, 2012a;Singh et al, 2012b;Malhotra and Do, 2012). There is also evidence to show that the public health personals provide services to their clients based on their own perceptions and beliefs rather than based on the needs of the clients (Pallikadavathet al, 2004;Matthews et al, 2001;Dhandapany et al, 2008).All these reduce the effectiveness of the public health services in India.…”

Antenatal care use in Brazil and India: Scale, outreach and socioeconomic inequality

“…The regional differences in India highlight socioeconomic differences and differential access to maternal and child health services (Singh et al, 2012;Pathak et al, 2010;Pallikadavath et al, 2004). Education and household wealth are particularly strong predictors of antenatal care use in India.…”