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Multiple Vulnerabilities in Utilising Maternal and Child Health Services in Uttar Pradesh, India
Although there are multiple vulnerabilities that may prevent access to maternal and child health services in India, the literature has so far focused on unidimensional vulnerabilities—typically, economic or social vulnerabilities. The linkages between multiple vulnerabilities and the utilisation of MCH services are investigated using data from National Family Health Survey-4 (2015–16) for Uttar Pradesh to analyse whether women received full antenatal care, institutional delivery care, postnatal care, and full immunisation for their children. Bivariate analysis and binomial logistic regression analysis are employed to examine the multiple vulnerabilities that service utilisation across three dimensions—education, wealth, and caste. Women with multiple vulnerabilities are less likely to utilise essential MCH services.
Although India has made considerable progress in achieving its Millennium Development Goals, it has laggedon several maternal and child health (MCH) indicators. A large percentage of maternal and child deaths in India are caused by low access to and underutilisation of essential health services. Several studies in India have reported on inequities in access to maternal healthcare between states, within states, and across regions (Navaneetham and Dharmalingam 2002; Subramanian et al 2006; Deaton and Drèze 2009). Further, access to MCH services varies across different segments of the population. Low education, lower social class, and poverty are significantly associated with lower utilisation of MCH services. Studies have also shown that the gap in various income groups’ access to maternal care is widening, with poor women receiving fewer services than those who are better off (Pandey et al 2004; Pathak et al 2010).
North Indian states like Uttar Pradesh, Bihar, and Jharkhand exhibit lower utilisation of MCH services compared to most of the south Indian states (Dehury and Samal 2016). The MCH services in Uttar Pradesh are particularly poor and different socio-economic groups have inequitable access to them. Although MCH care has improved in Uttar Pradesh over the last few decades, progress has been slow and uneven (Saroha et al 2008; Tripathi 2016). For example, the number of women who received antenatal care (ANC) for their last pregnancy and had an institutional delivery in Uttar Pradesh increased from 44.7% to 72% and from 11.2% to 67.8%, respectively, between 1992 and 2015; however, the existing rich–poor gap (that is, the ratio of the richest to the poorest wealth quintiles) in the use of ANC remained high over the period, while the ratio of institutional deliveries declined (IIPS and Macro International 1995; IIPS and ICF 2017). Similarly, the literacy ratio and the ratio of Scheduled Castes/Scheduled Tribes (SCs/STs) to other castes in the use of ANC has widened over the same period.
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