Department of Fertility Studies, International Institute for Population Sciences, Mumbai.
Int Perspect Sex Reprod Health. 2012 Mar;38(1):6-14. doi: 10.1363/3800612.
Research on inequalities in the utilization of maternal health care services is often confined to only the economic domain. Individuals and families living in acute poverty may simultaneously experience multiple dimensions of deprivation, which together may obstruct their access to basic health services. It is important to examine the linkages between multiple deprivations and maternal health care.
Data from the 2005-2006 Indian National Family Health Survey were used to examine ever-married women's receipt of antenatal care, medical assistance during delivery and postnatal care services across three dimensions of deprivation: education, wealth and health. Bivariate analyses, principal component analyses and binomial logistic regression analyses were conducted.
Thirty-two percent of ever-married Indian women reported being deprived in one of the three dimensions, 18% in two and 7% in all three; 43% were deprived in none. Women deprived in all three dimensions were less likely than those not deprived in any to have received antenatal care (predicted probabilities, 0.3 vs. 0.8) or postnatal care (0.2 vs. 0.7); the likelihood that a birth occurred with medical assistance was smaller for women deprived in three dimensions than for those deprived in none (0.2 vs. 0.8). These patterns held true for all of the larger Indian states. Differentials in utilization of maternal care services across deprivation levels were higher in states where service coverage was low and lower in states where service coverage was high.
More research is needed to understand how multiple deprivations are associated with health inequality across cultures and how to use this knowledge to improve delivery of basic health services.
对妇幼保健服务利用不平等的研究往往仅限于经济领域。生活在赤贫中的个人和家庭可能同时经历多种贫困维度，这些维度共同阻碍了他们获得基本卫生服务。因此，有必要考察多种贫困与妇幼保健之间的联系。
本研究使用了 2005-2006 年印度全国家庭健康调查的数据，考察了三个贫困维度（教育、财富和健康）下已婚妇女接受产前护理、分娩时医疗援助和产后护理服务的情况。进行了双变量分析、主成分分析和二项逻辑回归分析。
32%的已婚印度妇女在三个维度中的一个维度上处于贫困状态，18%在两个维度上，7%在三个维度上；43%的妇女在所有维度上都没有被剥夺。在所有三个维度上都被剥夺的妇女接受产前护理（预测概率，0.3 比 0.8）或产后护理（0.2 比 0.7）的可能性小于未被剥夺的妇女；在所有三个维度上都被剥夺的妇女在分娩时接受医疗援助的可能性比没有被剥夺的妇女要小（0.2 比 0.8）。这些模式在所有较大的印度邦都成立。在服务覆盖范围较低的邦，不同贫困程度的产妇保健服务利用差异较大，而在服务覆盖范围较高的邦，差异较小。
需要进一步研究如何在不同文化中理解多种贫困与健康不平等之间的关系，以及如何利用这一知识来改善基本卫生服务的提供。
