Faculty of Business, Government and Law, University of Canberra, Australian Capital Territory, Canberra, 2617, Australia.
Health Research Institute, Faculty of Health, University of Canberra, Australian Capital Territory, Canberra, 2617, Australia.
BMC Pregnancy Childbirth. 2022 Feb 25;22(1):155. doi: 10.1186/s12884-022-04441-4.
The introduction of Janani Suraksha Yojana (JSY) in India, a conditional cash transfer program which incentivized women to deliver at institutions, resulted in a significant increase in institutional births. Another major health policy reform, which could have affected maternal and child health care (MCH) utilization, was the public health insurance scheme (RSBY) launched in 2008. However, there is a noticeable lack of studies that examine how RSBY had impacted on MCH utilization in India. We used data from a cohort of mothers whose delivery had been captured in both the 2005 and 2011/12 rounds of the Indian Human Development Survey (IHDS) to study the impact of health insurance (in particular, the public insurance scheme versus private insurance) on MCH access. We also investigated whether maternal empowerment was a significant correlate that affects MCH utilization.
We used the multilevel mixed-effects ordered logistic regression model to account for the clustered nature of our data. We derived indexes for women's empowerment using Principal component analysis (PCA) technique applied to various indicators of women's autonomy and socio-economic status.
Our results indicated that the odds of mothers' MCH utilization levels vary by district, community and mother over time. The effect of the public insurance scheme (RSBY) on MCH utilization was not as strong as privately available insurance. However, health insurance was only significant in models that did not control for household and mother level predictors. Our findings indicated that maternal empowerment indicators - in particular, maternal ability to go out of the house and complete chores and economic empowerment-were associated with higher utilization of MCH services. Among control variables, maternal age and education were significant correlates that increase MCH service utilization over time. Household wealth quintile was another significant factor with mothers belonging to upper quintiles more likely to access and utilize MCH services.
Change in women's and societal attitude towards maternal care may have played a significant role in increasing MCH utilization over the study period. There might be a need to increase the coverage of the public insurance scheme given the finding that it was less effective in increasing MCH utilization. Importantly, policies that aim to improve health services for women need to take maternal autonomy and empowerment into consideration.
印度引入了 Janani Suraksha Yojana（JSY），这是一项有条件的现金转移计划，鼓励妇女在机构分娩，这导致机构分娩率显著上升。另一项重大的卫生政策改革是 2008 年推出的公共医疗保险计划（RSBY），这可能会影响母婴保健（MCH）的利用。然而，关于 RSBY 如何影响印度母婴保健利用的研究却很少。我们使用了在印度人类发展调查（IHDS）2005 年和 2011/12 年两轮调查中记录分娩情况的一组母亲的数据，来研究医疗保险（特别是公共保险计划与私人保险）对 MCH 获得的影响。我们还调查了产妇赋权是否是影响 MCH 利用的重要相关因素。
我们使用多层次混合效应有序逻辑回归模型来解释数据的聚类性质。我们使用主成分分析（PCA）技术从女性自主权和社会经济地位的各种指标中得出女性赋权指数。
我们的结果表明，母亲的 MCH 利用水平随时间在地区、社区和母亲层面上有所不同。公共保险计划（RSBY）对 MCH 利用的影响不如私人保险那么大。然而，医疗保险仅在不控制家庭和母亲层面预测因素的模型中具有显著意义。我们的研究结果表明，产妇赋权指标——特别是产妇外出和完成家务的能力以及经济赋权——与更高的 MCH 服务利用率相关。在控制变量中，母亲年龄和教育是随着时间推移增加 MCH 服务利用的重要相关因素。家庭财富五分位数是另一个重要因素，处于较高五分位数的母亲更有可能获得和利用 MCH 服务。
在研究期间，女性和社会对产妇保健态度的变化可能在增加 MCH 利用方面发挥了重要作用。鉴于公共保险计划在增加 MCH 利用方面效果较差，可能需要扩大其覆盖范围。重要的是，旨在改善妇女健康服务的政策需要考虑产妇自主权和赋权。
