In India, Cumulative Effects of Social Inequities Linked to Poor Maternal Health Care

Low Education, More Than Other Factors, Explains Gaps in Care

Women in India who are poor, have little education and are underweight face substantial barriers in obtaining access to appropriate maternal health care, according to "Multiple Deprivations and Maternal Care in India," a study by Sanjay K. Mohanty, of the International Institute for Population Sciences, Mumbai, released in the March issue of International Perspectives on Sexual and Reproductive Health. The study found wide inequalities in the provision of antenatal care, medical assistance at delivery and postnatal care among Indian women. Only 25% of women with a combination of low education, poverty and who were underweight received the recommended number of antenatal visits, compared with 71% of women who did not have any of these characteristics; just 17% of these women gave birth with medical assistance, compared with 69% of other women; and 20% received appropriate postnatal care, compared with 61% of other women.

Low education was more strongly associated with not receiving appropriate maternal health services than poverty or poor nutrition. In fact, the study, based on data from the 2005–2006 Indian National Family Health Survey, notes that after adjustment for social and demographic characteristics, only 33% of women who had completed fewer than five years of school had medical assistance at delivery, compared with 38% of women who were both poor and malnourished. Similarly, 42% of poorly educated women received appropriate antenatal care, compared with 48% of those who were both poor and malnourished.

Mohanty found that deprivation-related inequalities in maternal health services varied substantially across India’s 18 larger states. In general, the differences between women with multiple deprivations and those with none appeared to be highest in states where maternal health service coverage is low (such as Bihar, Uttarakhand, and Uttar Pradesh); and lowest in states where service coverage is high (such as Andhra Pradesh, Karnataka, Kerala, Orissa and Tamil Nadu). The author argues that the availability and accessibility of care in public health centers contribute to the differences in maternal care among Indian states.

In light of these findings, the author suggests using mass media and local health workers to get information to women with low education to promote their use of maternal health services. In addition, he suggests that more research is needed to understand how multiple deprivations are associated with health inequalities across cultures and how this information can be used to improve the delivery of basic health services.

The study, "Multiple Deprivations and Maternal Care in India," is currently available online and appears in the March 2012 issue of International Perspectives on Sexual and Reproductive Health.