Tripathi Pooja, Chakrabarty Mahashweta, Singh Aditya, Let Subhojit
Department of Geography, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
BMC Public Health. 2024 Dec 5;24(1):3378. doi: 10.1186/s12889-024-20714-3.
To further reduce maternal and neonatal mortality, it is essential for mothers and newborns to fully utilize all essential services within the continuum of maternal and newborn care. However, research on maternal and child health services in India has not sufficiently examined geographical disparities in the full utilization of these services and the factors influencing the full utilization, particularly in rural areas. This study aims to address this critical gap.
Utilizing data from 130,312 mothers collected in the National Family Health Survey-5 (2019-21), this study employed spatial analysis to uncover geographical disparities in the full utilization of the continuum of maternal and newborn healthcare services in rural India. Additionally, binary logistic regression was used to identify the factors associated with this utilization.
In rural India, 54.3% mothers recieved four or more antenatal care visits, 88.6% received skilled birth attendance, and 75.5% of mothers and 79.8% of newborns received postnatal care within 48 hours of birth. However, only 43.5% mothers-newborn dyads in rural India utilized all four services of the continuum of maternal and newborn healthcare. There were significant geographical disparities in the full utilization of the continuum of maternal and newborn healthcare services. Hotspots were primarily identified in districts of southern states, western Maharashtra, and central Odisha, while cold spots were evident in the northeastern states of Arunachal Pradesh, Meghalaya, Assam, and Nagaland, as well as in the Empowered Action Group states of Bihar, Uttar Pradesh, and Jharkhand. Key determinants influencing the full utilization of the continuum of care in rural India included maternal education, household wealth, parity, health insurance coverage, and exposure to mass media. Specifically, the odds of fully utilizing the continuum of care were significantly lower among women without formal education (adjusted odds ratio = 0.60, 95% CI = 0.56-0.65), those from the poorest wealth quintile (0.65, 0.61-0.69), and mothers with six or more children (0.42, 0.37-0.47), compared to mothers with higher education, those in the richest wealth quintile, and mothers with a single child, respectively. Additionally, mothers from the southern region were more than twice as likely (2.11, 1.99-2.20) to fully utilize the continuum of healthcare services compared to mothers from the northern region.
The significant geographical disparities in the full utilization of maternal and newborn healthcare services in rural India highlight the necessity for tailored, region-specific interventions. Future programs should focus on addressing the barriers to care by prioritizing vulnerable groups, including those who are poor, uninsured, less educated, adolescents, and women with high parity.
为进一步降低孕产妇和新生儿死亡率，母亲和新生儿充分利用孕产妇和新生儿连续照护中的所有基本服务至关重要。然而，印度关于妇幼保健服务的研究尚未充分考察这些服务充分利用方面的地理差异以及影响充分利用的因素，尤其是在农村地区。本研究旨在填补这一关键空白。
利用在第五轮全国家庭健康调查（2019 - 2021年）中收集的130312名母亲的数据，本研究采用空间分析来揭示印度农村地区孕产妇和新生儿连续医疗保健服务充分利用方面的地理差异。此外，使用二元逻辑回归来确定与这种利用相关的因素。
在印度农村地区，54.3%的母亲接受了四次或更多次产前检查，88.6%的母亲接受了熟练的助产服务，75.5%的母亲和79.8%的新生儿在出生后48小时内接受了产后护理。然而，在印度农村地区，只有43.5%的母婴二元组利用了孕产妇和新生儿连续医疗保健的所有四项服务。孕产妇和新生儿连续医疗保健服务的充分利用存在显著的地理差异。热点主要出现在南部各邦的地区、马哈拉施特拉邦西部和奥里萨邦中部，而冷点在阿鲁纳恰尔邦、梅加拉亚邦、阿萨姆邦和那加兰邦等东北部邦以及比哈尔邦、北方邦和贾坎德邦等赋权行动小组邦很明显。影响印度农村地区连续照护充分利用的关键决定因素包括母亲的教育程度、家庭财富、胎次、医疗保险覆盖范围和接触大众媒体的情况。具体而言，与受过高等教育的母亲、最富有财富五分位数的母亲和只有一个孩子的母亲相比，未受过正规教育的女性（调整后的优势比 = 0.60，95%置信区间 = 0.56 - 0.65）、最贫困财富五分位数的女性（0.65，0.61 - 0.69）以及有六个或更多孩子的母亲（0.42，0.37 - 0.47）充分利用连续照护的几率显著更低。此外，与来自北部地区的母亲相比，来自南部地区的母亲充分利用连续医疗保健服务的可能性高出两倍多（2.11，1.99 - 2.20）。
印度农村地区孕产妇和新生儿医疗保健服务充分利用方面的显著地理差异凸显了针对性的、因地制宜干预措施的必要性。未来的项目应通过优先关注弱势群体，包括贫困、未参保、受教育程度低、青少年以及多胎次女性等，来解决照护障碍。
