scholarly journals Out of pocket expenditure for availing maternal health care services in Northern India

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Singh ◽  
P Jain ◽  
S Kumar ◽  
S Singh ◽  
N Singh
Keyword(s):  
Public Health ◽  
Health Care ◽  
Maternal Health ◽  
Health Facility ◽  
Health Care Services ◽  
Public Health Facility ◽  
Maternal Health Care ◽  
Health Care Facilities ◽  
Care Services ◽  
Maternal Health Care Services

Abstract Introduction Maternal and child health comprise one of the most important parameters of the health situation in a country at any given time. Maternal and new born child's health are inter-related to a great extent and while improving one, we might greatly affect the other; hence, joint efforts are required to cope with the rising demands of better healthcare for both. Out-of-pocket expenditure act as a major deterrent, especially to underprivileged communities, in accessibility to maternal health care services and knowledge of the determinants of maternity related expenses helps in outlining policies. Material and Methods This is a community based cross sectional study conducted in state of Uttar Pradesh between July 2019 to December 2019 among 848 women who delivered in past six months at a public health facility. A pretested, semi structured questionnaire was used to collect data. The data thus collected was entered into Microsoft Excel spreadsheet and was analysed using Statistical Package for Social Sciences (SPSS) version 24.0, IBM Inc. Chicago, USA software. Results The analysis showed that the median OOPE was INR 1000 (US$ 13.89) which varied between INR 950 (US$ 13.19) for normal delivery and INR 4900 (US$ 68) for caesarean section. OOPE for availing diagnostic facilities especially ultrasound with a median value of INR 500 (US$ 6.94) contributed to the major share. Women from households with income more than INR 7500 (US$ 104.17) per month, education higher than high school, primi-gravida, occupation of mother and type of delivery were significant predictors for high OOPE. Awareness level about various free entitlements in public health facility was significantly associated with overall out of pocket expenditure. Conclusions Although services at the public health facility in India are supposedly provided free of cost, considerable out of pocket expenditure is still incurred on beneficiaries while availing maternity services. Key messages Out of pocket expenditure is a major deterrent in availing institutional deliveries in public health facilities. Zero-cost, equitable and accessible maternal health care services through timely access to health care facilities is of paramount importance for reducing MMR and IMR in every country.

scholarly journals Determinants of Maternal Health Care Utilization in the Era of Free Maternity Services in Busia County, Kenya

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
B. Wafula ◽  
J. Arudo ◽  
M. Kipmerewo
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Utilization ◽  
Health Facility ◽  
Health Care Services ◽  
Maternal Health Care ◽  
Care Utilization ◽  
Maternal Health Care Utilization ◽  
Care Services ◽  
Maternal Health Care Services

Purpose. The main objective was to establish determinants of maternal health care utilization and specifically to assess the trends of maternal health care utilization and determine the predictors of maternal health care service utilization in the era of free maternity policy in Busia County. Methodology. It was a cross-sectional study design. The study was conducted between February and April 2019. The research targeted mothers within childbearing age of 15-49 years and a sample size of 634 mothers was used. Quantitative data were analyzed using SPSS version 22.0. Descriptive statistics was used to describe results on socio-demographic characteristics while inferential statistics employed bivariate and multivariate logistic regressions to investigate determinants of maternal health care utilization. Odds ratio was used to test the strength of association, and a p-value of ≤ 0.05 considered as statistically significant.  Results. In 2010, FANC increased by 5.6% from 2010 (pre-free maternity period) to 2017 (post-free maternity era). There was also an increase of 2.2% cases of health facility deliveries during pre-free maternity period (2010) and post-free maternity period (2017). Eleven predictors of maternal health care utilization were identified. Among them were respondent being a farmer (OR = 2.6; 95% CI: 1.4-4.8; p = 0.002), the status of the infrastructure of the nearest health facility maternity being good (OR = 3.2; 95% CI: 1.1-9.6; p = 0.03), fare for the public vehicle being USD 0.2 (OR = 3.4; 95% CI: 1.6-7.1; p = 0.001), all maternal health services being available in the nearest health facility (OR = 3.1; 95% CI: 1.8-5.4; p<0.0001), difficulty to attend MCH services due to non-suitability of working days (OR = 2.7; 95% CI: 1.5-4.7; p=0.0008), there being some services that clients pay for (OR = 3.3; 95% CI: 1.5-7.4; p=0.004), services being provided by nurses (midwives) (OR = 2.3; 95% CI: 1.0-4.9; p=0.04) , baby checkup being done within 24 hours by nurses (OR = 18.8; 95% CI: 8.0-44.0; p<0.0001. In conclusion, free maternity care program has led to increased utilization of facility ANC visits and deliveries in the study area. Barriers related to utilization of maternal health care services included unreliable transport especially at night, limited infrastructure and low socio-economic status of the women in the study area. National and county governments need to put in place strategies which will help them to jointly assess, map and plan investments to improve utilization of maternal health care services through prioritizing investments in human resource, infrastructure and commodities based on the anticipated demand for such services. A unique contribution to theory, practice, and policy: The study findings identified key factors that are unique to the mothers in Busia County on predisposing factors, enabling factors and the need characteristics that determine utilization of maternal health care in the era of Free Maternity services in the study area. These results contribute to both maternal health care utilization and policy change that could directly meet the social setting, geographical location and cultural needs of the people of Busia County.

scholarly journals Utilization pattern and associated factors of maternal health care services in Haryana, India: a study based on district level household survey data

2018 ◽  
Vol 7 (3) ◽  
pp. 1154 ◽  
Author(s):  
Shinjini Ray ◽  
Pravat Bhandari ◽  
Jang Bahadur Prasad
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Antenatal Care ◽  
Health Care Services ◽  
Institutional Delivery ◽  
Maternal Mortality Ratio ◽  
Maternal Health Care ◽  
District Level ◽  
Care Services ◽  
Maternal Health Care Services

Background: Maternal health was one of the most important millennium development goals (MDGs), India didn’t achieve by the year 2015. Since, India is a multicultural, social and multiregional country, where some of the regions have good social and demographic achievement while some are poor. Haryana is one of them, which has 146 maternal mortality ratio. The level of receiving antenatal care (ANC) in Haryana is quite low as compared to other states of India. Objective of present study was to Understand the extent of use of maternal health care services in Haryana as well as examining the role of antenatal care and other socio-economic factors on the utilization of maternal health services.Methods: Bivariate analysis, chi-square test, and binary logistic regression have been used based on district level household and facility survey-4 data.Results: The utilization of ANC (any and full), institutional delivery and post-delivery treatment seeking varies among women by literacy, age at first marriage, age at women and place of residence. Literate women are two times more likely to access ANC [odds ratio (OR)=1.97 (any ANC), 1.95 (full ANC), p<0.01] and 1.52 times more likely to prefer institutional delivery [OR=1.52, p<0.01].Conclusions: Empowering women through the encouragement of mother’s education should be one of the most fundamental strategies to promote maternal health care services and reduce inequalities.

DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA

2017 ◽  
Vol 50 (6) ◽  
pp. 749-769 ◽  
Author(s):  
Srinivas Goli ◽  
Dipty Nawal ◽  
Anu Rammohan ◽  
T. V. Sekher ◽  
Deepshikha Singh
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Services ◽  
Socioeconomic Inequalities ◽  
Maternal Health Care ◽  
Health Care Use ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Care Services ◽  
Maternal Health Care Services

SummaryThe gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010–11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of −0.1147, −0.1146, −0.2859 and −0.0638 for <3 antenatal care visits; CI of −0.1338, −0.0925, −0.1960 and −0.2531 for non-institutional delivery; and CI of −0.1153, −0.0370, −0.1817 and −0.0577 for no postnatal care within 2 days of delivery for Bangladesh, Ethiopia, Nepal and Zimbabwe, respectively. The marginal effects suggested that the strength of the association between the outcome and explanatory factors varied across the different countries. Decomposition estimates revealed that the key contributing factors for socioeconomic inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.

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