Trends in Use of Maternity Care in India: Growing Disparity Across Different Ethnic Groups

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Many previous studies have examined growing rich-poor gap in use of maternity services in Southeast Asia. Hence, the public health interventions in the region have focused to increase coverage of maternity services among poor. However, identification of the poor is a big challenge in the region because of a corrupt political system and biased policies. Alternatively, it is better to target some ethnic groups – who are socially disadvantaged and face discrimination. This would be worthwhile to further reduce maternal mortality ratio in Southeast Asia. This paper examines the trends and pattern in use of full antenatal care and medical assistance at delivery by ethnic groups in Bangladesh, Indian, Nepal, and Pakistan.

Methods: Country specific multi-rounds of the Demographic and Health Surveys conducted in last 15-20 years were analysed. Country specific ethnic groups are created and disparity in use of the services is analyzed between groups. Bivariate, inequality and multivariate analysis were used to understand the trends in ethnic disparity with respect to use of the maternity services.

Results: A huge gap exists in coverage of the services between ethnic groups in Southeast Asia – use of services are 20-35 percent lower among marginalized ethnic groups than their counterparts. Moreover, there is sluggish change coupled with the concomitant rise in ethnic disparities with respect to use of the services cutting across the countries. In addition, average increase in coverage of the services concealed large ethnic disparity in the region. Interestingly, ethnic gap in use of the services remained persistent even after interacting with household wealth.

Conclusions: Though there is provision of reservation for marginalized ethnic groups for enrolment in government universities and in government jobs. There is need for special policy in a similar way to increase the coverage of maternity services among marginalized ethnic groups of the region.