Is economic inequality in maternal and child healthcare decreasing in India? Trends between 2005-2006, 2015-2016 and 2019-2021.

OBJECTIVE

This study examined economic inequality in coverage of selected maternal and child healthcare (MCH) indicators in India and its states over the last 15 years.

DESIGN

The study analysed last three rounds of the National Family Health Survey data, conducted during 2005-2006, 2015-2016 and 2019-2021. Bivariate analyses, ratio of richest to poorest, slope index of inequality (SII) and multivariate binary logistic regression analyses were used to examine the coverage as well as inequalities in the outcome indicators for India and its states and at district level.

PRIMARY OUTCOMES

The outcome variables analysed in the study were full antenatal care, institutional delivery, postnatal care of mothers within 48 hours of delivery, and full immunisation among children.

PARTICIPANTS

Women aged 15-49 who had given a birth in the last 5 years before the surveys were unit of analysis for the maternal healthcare indicators, and children aged 12-23 months were unit of the analysis for childhood immunisation.

RESULTS

Over the last 15 years, coverage of the MCH indicators has increased in India and across socioeconomic segment of the population, and the absolute increase was higher among the worse-off segments than the better-off. This led to decline in the inequality in coverage of all the MCH indicators. For instance, the value of SII for institutional births decreased from 0.76 in 2005-2006 to 0.45 in 2015-2016 and further to 0.37 in 2019-2021. Although inequality has decreased, geographic disparities persist across states and districts.

CONCLUSION

Though substantial improvement was observed, coverage of MCH indicators increased and the economic inequality declined; certain geographies are still characterised with the low coverage and persistent high inequality. This suggests that adding a spatial perspective to the inequality research and targeted strategies is essential for achieving universal access to reproductive healthcare services by 2030 in India.