Wealth index and maternal health care: Revisiting NFHS-3

Abstract

The third National Family Health Survey (NFHS-3) is a large dataset on indicators of family welfare, maternal and child health, and nutrition in India. This article using NFHS-3 data is an attempt to bring out the impact of economic status, i.e., the wealth index on maternal health. The study was based on an analysis of the NFHS-3 data. Independent variables taken were the wealth index, literacy, and age at first child birth. Effects of these variables on the maternal health care services were investigated. Out of the total 124,385 women aged 15-49 years included in the NFHS-3 dataset, 36,850 (29.6%) had one or more childbirth during the past 5 years. The number of antenatal care (ANC) visits increased as the wealth index increased and there was a pattern for choice of place of delivery (for all deliveries during the last 5 years) according to the wealth index. Logistic regression analysis of the abovementioned variables were sought to find out the independent role of key determinants of the different aspects of maternal health care. It showed that the wealth index is the leading key independent determinant for three or more ANC received: Tetanus toxoid (TT) received before delivery, iron tablet/syrup taken for more than 100 days, and institutional delivery. Mother's literacy was the leading independent key determinant for early antenatal registration. The study suggested that along with the mother's literacy, the wealth index that is an important predictor of maternal health care can be added for categorization of the districts for providing differential approach for maternal health care services.

Utilization of institutional delivery services across successive births in India

“…Previous studies have shown a linear increase in institutional delivery with an increase in wealth quintiles (Chakraborty, Islam, Chowdhury et al, 2003;Gabrysch and Campbell 2009;Goel, Roy, Rasania et al, 2015;Kesterton, Cleland, Slogett et al, 2010;Titaley, Dibley, and Roberts, 2010;Vora, Mavalankar, Ramani et al, 2009), the present study also showed a similar finding in the case of consistent utilization of institutional delivery. Despite different government incentive programs, the high cost of delivery care is often blamed for the low rate of delivery service utilization, especially for poorer women.…”

Economic Status and Maternal Health: Analysis of the 2013-14 Zambia Demographic and Health Survey

“…In terms of wealth, the results show that the odds of the mother making 4 or more ANC visits increased as the wealth increased. This result is consistent with the findings of a study by [20] in which it was found that the number of ANC visits increased as the wealth index increased. This finding can be explained by the fact that wealthier women have a higher ability to pay and therefore seek more ANC as compared to those who are poor.…”

“…According to the table, women who were in the Poorer, middle, richer and richest wealth quintiles had 30%, 50%, 180% and 640% respectively higher odds of delivering their newborns in a health facility compared to those in the poorest quintile. This result is in line with the finding of [20] in their study of the Wealth Index and Maternal Health Care. The explanation for this is that with higher wealth, the mother is able to have access to health facilities where she can receive proper maternal health care services during delivery from well-trained medical personnel.…”

“…This study is unique in the sense that it uses an index of wealth to measure economic status, while several studies conducted in low-income countries have used socioeconomic status as an important determinant of maternal health care service utilization [4,16,17,18]. The wealth index is used because it is a much broader indicator of wealth as it is consistent with expenditure and income measures [20]. This study also adds to literature in Zambia as similar studies undertaken in Zambia [5,19] have not explored the effect of economic status on maternal health care.…”

“…These factors can, however, be classified into two: Socio-economic and demographic. Socio-economic factors include region, place of residence, wealth index, literacy and Access to Media, while Demographic factors include Mothers age at first child birth and Marital Status [15,20,21]. Also, this study uses a composite measure of five different variables (number of antenatal care (ANC) visits, timing of first ANC visit, tetanus toxoid (TT) vaccination, iron tablet/syrup uptake, and place of delivery) as a proxy for maternal health services.…”