Bango Madhumita, Ghosh Soumitra
School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India.
Centre for Health, Policy, Planning, and Management, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India.
Front Pediatr. 2022 Jun 14;10:895033. doi: 10.3389/fped.2022.895033. eCollection 2022.
India has enjoyed enhanced economic growth, but has fared poorly in human development indicators and health outcomes, over the last two decades. Significant health inequities and access to healthcare continue to exist and have widened within communities across states. This study examine the changes and disparities in maternal and child healthcare (MCH) among disadvantaged and advanced social groups in three states of India.
Four rounds of National Family Health Survey data were used to measure infant mortality rate (IMR) and under-five mortality rate (U5MR) according to the social groups for the selected states. This study investigates the socio-economic inequities manifested into caste and class differentials and inequities in availability, utilization, and affordability of maternal and healthcare services. Descriptive statistics and the logistic regression model were used. Individual- and household-level covariates were employed to understand the differentials in healthcare utilization.
The probability of not receiving full antenatal care (ANC) or full immunization for the children was highest among the Scheduled Caste/Scheduled Tribe (SC/ST) families, followed by economic class, mother's education and residence. Tamil Nadu showed the highest utilization of public health facilities, while Bihar was the poorest in terms of health outcomes and utilization of MCH care services even after the pre-National Health Mission (NHM) period. Bihar and West Bengal also showed private healthcare dependence.
This study detected the presence of significant caste/tribe differentials in the utilization of MCH care services in the selected states of India. Limited accessibility and unavailability of complete healthcare were the foremost reasons for the under-utilization of these services, especially for people from disadvantaged social groups. The result also suggested that it is perilous to confirm "Health for All" immediately. It will be the efficiency with which India addresses inequities in providing healthcare services and guarantees quality care of health services.
在过去二十年中，印度经济实现了增长，但在人类发展指标和健康成果方面表现不佳。严重的健康不平等以及获得医疗保健的机会问题依然存在，并且在各邦的社区内部差距有所扩大。本研究考察了印度三个邦中弱势群体和社会地位较高群体在母婴保健（MCH）方面的变化和差异。
利用四轮全国家庭健康调查数据，根据选定邦的社会群体来衡量婴儿死亡率（IMR）和五岁以下儿童死亡率（U5MR）。本研究调查了表现为种姓和阶层差异的社会经济不平等，以及母婴保健服务在可及性、利用率和可负担性方面的不平等。使用了描述性统计和逻辑回归模型。采用个人和家庭层面的协变量来了解医疗保健利用方面的差异。
在在册种姓/在册部落（SC/ST）家庭中，儿童未接受全程产前护理（ANC）或全程免疫的可能性最高，其次是经济阶层、母亲的教育程度和居住地。泰米尔纳德邦公共卫生设施的利用率最高，而比哈尔邦即使在国家卫生使命（NHM）实施前阶段之后，在健康成果和母婴保健服务利用方面也是最差的。比哈尔邦和西孟加拉邦还表现出对私立医疗保健的依赖。
本研究发现，在印度选定的邦中，母婴保健服务利用方面存在显著的种姓/部落差异。可及性有限和无法获得全面医疗保健是这些服务利用不足的首要原因，尤其是对弱势群体而言。结果还表明，立即宣称“全民健康”是危险的。这将取决于印度解决医疗保健服务不平等问题并确保医疗服务质量的效率。
