评估印度孕妇对政府项目和服务的利用情况。
Assessment of utilisation of government programmes and services by pregnant women in India.
机构信息
Institute for Human Development, Delhi, India.
Institute of Economic Growth, North Campus, Delhi University, Delhi, India.
出版信息
PLoS One. 2023 Oct 5;18(10):e0285715. doi: 10.1371/journal.pone.0285715. eCollection 2023.
BACKGROUND
Since the implementation of various maternal health programs, Maternal Mortality Ratio (MMR) has significantly declined in India through improvements in maternal health services. However, inequality persists at the regional and socio-economic levels. In light of this, the present study aims to assess the existing regional disparities in utilising various government initiatives for safe motherhood in India.
METHODS
National-level datasets such as National Family and Health Surveys (NFHS-3 (2005-06); NFHS-4 (2015-16) and NFHS-5(2019-21); Health Management Information System (HMIS), 2019-20; Sample Registrar System (SRS), 2001-2018) were used in the study. In addition, composite Index and inequality measures (Range, Ratio, and Gini) were calculated to examine inequality. At the same time, the Pearson correlation was used to investigate the correlation between various components of maternal health services and Maternal Mortality Rate (MMR).
RESULTS
The composite index score (0.65) reflects that India is still far behind the targets of the utilisation of maternal health care services. Within the utilisation of services, the Gini coefficient reveals that the least inequality was recorded in skilled birth assistance deliveries (0.03) and institutional deliveries (0.04). In contrast, the highest inequality was recorded in receiving Iron and Folic Acid (IFA) Tablets for 100 days (0.19) and four Antenatal Care (ANC) visits (0.13) among selected states. Based on the composite score for maternal health utilisation, Kerala, Tamil Nadu, Andhra Pradesh, Odisha, and Delhi were amongst the best performers, whereas Bihar, Jharkhand, Uttar Pradesh, and Assam were amongst the worst performers.
CONCLUSION
This indicates that the government's single-minded focus on enhancing institutional deliveries and skilled health-assisted deliveries has detracted from other essential interventions related to maternal health. Therefore, the states with the utilisation of maternal services need to initiate immediate action to increase the ANC and Post-natal Care (PNC utilisation with more attention towards better implementation of existing ANC programmes by the government.
背景
自实施各项妇幼健康项目以来，印度通过改善妇幼保健服务，使母婴死亡率（MMR）显著下降。然而，区域和社会经济层面仍存在不平等现象。有鉴于此，本研究旨在评估印度利用各种政府倡议实现安全孕产方面现有的区域差异。
方法
本研究使用了国家级数据集，如国家家庭健康调查（NFHS-3（2005-06 年）；NFHS-4（2015-16 年）和 NFHS-5（2019-21 年）；卫生管理信息系统（HMIS），2019-20 年；样本登记系统（SRS），2001-2018 年）。此外，还计算了综合指数和不平等衡量指标（范围、比率和基尼系数），以检查不平等现象。同时，使用皮尔逊相关系数来研究母婴保健服务的各个组成部分与母婴死亡率（MMR）之间的相关性。
结果
综合指数得分（0.65）反映出印度在利用妇幼保健服务方面仍远远落后于目标。在服务利用方面，基尼系数表明，接受熟练接生和住院分娩的不平等程度最低（分别为 0.03 和 0.04）。相比之下，在选定州中，接受铁和叶酸（IFA）片剂 100 天和四次产前护理（ANC）就诊的不平等程度最高（分别为 0.19 和 0.13）。根据母婴保健利用的综合评分，喀拉拉邦、泰米尔纳德邦、安得拉邦、奥里萨邦和德里邦是表现最好的邦，而比哈尔邦、恰尔康得邦、北方邦和阿萨姆邦则是表现最差的邦。
结论
这表明政府一味专注于提高机构分娩和熟练卫生协助分娩的数量，而忽略了与母婴健康相关的其他重要干预措施。因此，在利用母婴服务方面表现较好的邦需要立即采取行动，增加 ANC 和产后护理（PNC）的利用，更加关注政府更好地实施现有的 ANC 计划。
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