Equity in coverage of maternal and newborn care in India: evidence from a nationally representative survey

2020 ◽  
Vol 35 (5) ◽  
pp. 616-623 ◽  
Author(s):  
Yuvaraj Krishnamoorthy ◽  
Marie Gilbert Majella ◽  
Sathish Rajaa
Keyword(s):  
Child Health ◽  
Health Survey ◽  
Maternal And Child Health ◽  
Rural Areas ◽  
Concentration Index ◽  
Newborn Care ◽  
Child Health Services ◽  
Theil Index ◽  
Geographical Regions ◽  
And Child Health

Abstract Despite efforts taken by the Government of India, mothers and newborns are excluded from the maternal and child health services, especially those in poorer and weaker sections of the society. Hence, we have utilized the most recent National Family Health Survey (NFHS-4) data to assess the socio-economic inequities in antenatal care (ANC), intranatal care and postnatal care (PNC) coverage for mothers and newborns in India. We have analysed the NFHS-4 data gathered from the Demographic Health Survey programme. Stratification and clustering in the sample design were accounted for using ‘svyset’ command. Point estimates were reported as proportions with 95% confidence interval. The concentration curve and index were used to represent the socio-economic inequities. Theil index was computed to report inequities across geographical regions and place of residence. In total, 190 797 women who had at least one live birth in the preceding 5 years were included. About 52.1% of women had at least four ANC visits and 81.4% had institutional delivery. About 25.2% and 27.1% of the newborn received PNC within 24 and 48 h of delivery. The proportion of women who received PNC within 24 and 48 h after the delivery was 63.4% and 65.2%, respectively. Maximum inequity was observed for ANC (concentration index—0.195) followed by receipt of PNC by mothers within 24 and 48 h (concentration index—0.106 and 0.103). Women from the rural areas had a disproportionately high proportion of home deliveries (Theil index—3813.6). The findings from this study inform the policymakers and planners about the socio-economic inequity existing across various maternal and child health indicators. This will help them in making informed decisions and strengthen the maternal and child health programme in our country.

scholarly journals Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

2015 ◽  
Vol 8 (7) ◽  
pp. 47 ◽  
Author(s):  
Zahid Memon ◽  
Shehla Zaidi ◽  
Atif Riaz
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Community Health ◽  
Community Health Workers ◽  
Maternal And Child Health ◽  
Rural Areas ◽  
Health Workers ◽  
Functional Health ◽  
Child Health Services ◽  
And Child Health

<p>Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers.</p>

scholarly journals Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China: A cluster controlled design

2019 ◽  
Author(s):  
Huan Zhou ◽  
Yuju Wu ◽  
Chengfang Liu ◽  
Chang Sun ◽  
Yaojiang Shi ◽  
...  
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Breast Feeding ◽  
Maternal And Child Health ◽  
Rural Areas ◽  
Western China ◽  
Child Health Services ◽  
Child Health Outcomes ◽  
The Impact ◽  
And Child Health

Abstract Background: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that low uptake of MCH services may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that conditional cash transfer (CCT) have on the uptake of MCH services and ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services and health outcomes among children in poor rural areas of western China. Methods: We designated two different sets of comparison villages and households that were used as comparison against which outcomes of the treated households could be assessed. We conducted a large-scale survey of 1,522 households at 75 villages (including 25 treatment and 50 comparison) from nine nationally-designated poverty counties in two provinces of China in 2014. In each village, 21 households were selected based on their eligibility status for the CCT program. Propensity score matching analyses were used to assess the impact of CCT on outcomes in terms of both Intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT). Results: Overall, the uptake of MCH services in the sample households were low, especially in terms of post-partum care visit, early breast feeding, exclusive breast feeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages was significantly higher than that in the comparison villages. Results from both the ITT and ATT analyses showed the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers about MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes. Conclusions: The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two possible reasons: poor CCT implementation and the low quality of the rural health facilities.

scholarly journals Conditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural ChinaConditional cash transfers, uptake of maternal and child health services, and health outcomes in western rural China

2020 ◽  
Author(s):  
Huan Zhou ◽  
Yuju Wu ◽  
Chengfang Liu ◽  
Chang Sun ◽  
Yaojiang Shi ◽  
...  
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Maternal And Child Health ◽  
Rural Areas ◽  
Cash Transfers ◽  
Western China ◽  
Child Health Services ◽  
Child Health Outcomes ◽  
The Impact ◽  
And Child Health

Abstract Background: Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that the low uptake of MCH services may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that conditional cash transfers (CCT) have on the uptake of MCH services and ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.Methods: We designated two different sets of comparison villages and households that were used as comparison against which outcomes of the treated households could be assessed. In 2014 we conducted a large-scale survey of 1,522 households at 75 villages (including 25 treatment and 50 comparison) from nine nationally-designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both Intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).Results: Overall, the uptake of MCH services in the sample households were low, especially in terms of post-partum care visits, early breast feeding, exclusive breast feeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. Results from both the ITT and ATT analyses showed the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers about MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.Conclusions: The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two possible reasons: poor CCT implementation and the low quality of rural health facilities.

Mapping of Household Surveys to Measure Barriers to Access to Maternal and Child Health Services in India

2021 ◽  
Vol 23 (1) ◽  
pp. 10-19
Author(s):  
Shivam Gupta ◽  
Priyanka Das ◽  
Siddhartha Kumar ◽  
Arindam Das ◽  
P. R. Sodani
Keyword(s):  
Child Health ◽  
Health Services ◽  
Health Survey ◽  
Maternal And Child Health ◽  
Household Surveys ◽  
Access Barriers ◽  
Health Service Provision ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs ◽  
And Child Health

Objective: To map the range of access barrier indicators for which data can be derived from the three most common health related household surveys in India. Methods: A mapping review study was conducted to identify access dimensions and indicators of access barriers for maternal and child health (MCH) services included in three household surveys in India: National Family Health Survey (NFHS), District Level Household and Facility Survey (DLHS) and Annual Health Survey (AHS). Results: The Tanahashi framework for effective coverage of health services was used in this study, and 12 types of access barriers were identified, from which 23 indicators could be generated. These indicators measure self-reported access barriers for unmet healthcare needs through delayed care, as well as forgone care, and unsatisfactory experiences during health service provision. Multiple barriers could be identified, although there was marked heterogeneity in variables included and how barriers were measured. Conclusions: This study identified tracer indicators that could be used in India to monitor the population that experiences healthcare needs but fails to seek and obtain appropriate healthcare, and determine what the main barriers are. The surveys identified are well validated and allow the disaggregation of these indicators by equity stratifiers. Given the variability of the frequency and methodologies used in these surveys, comparability could be limited.

Child Saving and Child Spacing in Africa: The Evolution of a Concept

1973 ◽  
Vol 3 (4) ◽  
pp. 765-768
Author(s):  
Robert D. Wright
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Maternal And Child Health ◽  
Child Death ◽  
Child Health Services ◽  
Tropical Africa ◽  
Low Visibility ◽  
Child Spacing ◽  
High Level ◽  
And Child Health

In tropical Africa the primordial presence of enormous young child death rates precludes a successful frontal attack on birth rates through specialized programs. Experience in Nigeria indicates that gradual, quiet pressure can influence the power structure to tolerate and eventually espouse child spacing as an integral part of a program of services for child saving. The approach involves four phases: a low visibility start; obtaining high level acceptance; establishment of a federal training center to train cadres for state training programs; and deployment of trained primary care auxiliaries as a local maternal and child health-family planning service. In tropical Africa governmental attitudes toward family planning range from positive policy, to neutrality, to strong opposition. At present most Anglophone countries are favorable. Most Francophone countries are opposed. The general trend is toward a more favorable attitude toward family planning when it is a part of maternal and child health services.

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