Public Health Foundation of India, New Delhi, India
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
BMJ Open. 2024 Nov 21;14(11):e083922. doi: 10.1136/bmjopen-2024-083922.
The objective of this study is to examine the trends in geographical inequality of opportunity in maternal health services in India considering the Every Newborn Action Plan (ENAP) 2025 coverage targets.
India.
Women in the National Family Health Survey (NFHS)-NFHS-4 (2014-2015) and NFHS-5 (2019-2021).
District-level coverages of 4+antenatal care (ANC) visits, institutional delivery with skilled birth attendant, postnatal care (PNC) services within 48 hours of delivery, continuum of care (CoC) services for women with most recent live births were considered. Human Opportunity Index (HOI) documented the opportunities for equitable access to these services, ranging from 0 (high inequality) to 100 (universal access). HOI was compared between the survey rounds and wealth index (WI) quintiles that the women belonged to.
Coverages of 4+ANC visits, institutional delivery, PNC and CoC in India increased by 22.8% (95% CI 22.1% to 23.5%), 12.6% (95% CI 12.2% to 12.9%), 28.5% (95% CI 28.0% to 29.0%) and 38.6% (95% CI 37.6% to 39.6%) between NFHS-4 and NFHS-5, respectively. The HOI for 4+ANC visits was 48.4 in NFHS-5, ranging from 11.3 to 92.4 in states and from 31.1 to 70.5 for WI I-V. The HOI for institutional delivery was 80.4 in NFHS-5, ranging from 37.4 to 99.7 in the states and from 21.0 to 100 for WI I-V. The HOI for PNC services was 73.5 in NFHS-5, ranging from 37.5 to 95.6 in the states and from 61.2 to 88.3 for WI I-V. The HOI for CoC was 37.1, ranging from 6.5 to 88.8 in the states and from 19.8 to 62.7 for WI I-V for CoC in NFHS-5.
Though significant improvements in the geographical inequity of maternal health services have been made in India, the geographical inequity for 4+ANC visits coverage lags significantly behind resulting in CoC coverage inequity to achieve the ENAP targets for these services.
本研究旨在考察印度产妇保健服务机会的地域不平等趋势，同时考虑到 2025 年《每个新生儿行动计划》（ENAP）的覆盖目标。
印度。
参与 2014-2015 年国家家庭健康调查（NFHS-NFHS-4）和 2019-2021 年 NFHS-5 的女性。
本研究考虑了地区层面的四项产前护理（ANC）就诊、有熟练接生员的机构分娩、分娩后 48 小时内的产后护理（PNC）服务以及最近活产的妇女的护理连续性（CoC）服务的覆盖情况。记录了这些服务公平获取机会的人类机会指数（HOI），范围从 0（高度不平等）到 100（普遍获取）。HOI 还在两轮调查之间以及妇女所属的财富指数（WI）五分位数之间进行了比较。
NFHS-5 中，4+ANC 就诊、机构分娩、PNC 和 CoC 的覆盖率分别增加了 22.8%（95%CI 22.1%至 23.5%）、12.6%（95%CI 12.2%至 12.9%）、28.5%（95%CI 28.0%至 29.0%）和 38.6%（95%CI 37.6%至 39.6%）。NFHS-5 中，4+ANC 就诊的 HOI 为 48.4，各州的 HOI 范围为 11.3 至 92.4，WI I-V 的 HOI 范围为 31.1 至 70.5。NFHS-5 中，机构分娩的 HOI 为 80.4，各州的 HOI 范围为 37.4 至 99.7，WI I-V 的 HOI 范围为 21.0 至 100。NFHS-5 中，PNC 服务的 HOI 为 73.5，各州的 HOI 范围为 37.5 至 95.6，WI I-V 的 HOI 范围为 61.2 至 88.3。NFHS-5 中，CoC 的 HOI 为 37.1，各州的 HOI 范围为 6.5 至 88.8，WI I-V 的 HOI 范围为 19.8 至 62.7。
尽管印度产妇保健服务机会的地域不平等状况有了显著改善，但 4+ANC 就诊覆盖率的地域不平等仍严重滞后，导致 CoC 覆盖率的不平等，从而无法实现这些服务的 ENAP 目标。
