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Has India’s national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study

Has India’s national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study
Has India’s national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study
Background: In 2005, India launched the National Rural Health Mission (NRHM) to strengthen the primary healthcare system. NRHM also aims to encourage pregnant women, particularly of low socioeconomic backgrounds, to use institutional maternal healthcare. We evaluated the impacts of NRHM on socioeconomic inequities in the uptake of institutional delivery and antenatal care (ANC) across high-focus (deprived) Indian states.

Methods: Data from District Level Household and Facility Surveys (DLHS) Rounds 1 (1995–99) and 2 (2000–04) from the pre-NRHM period, and Round 3 (2007–08), Round 4 and Annual Health Survey (2011–12) from post-NRHM period were used. Wealth-related and education-related relative indexes of inequality, and pre-post difference-in-differences models for wealth and education tertiles, adjusted for maternal age, rural-urban, caste, parity and state-level fixed effects, were estimated.

Results: Inequities in institutional delivery declined between pre-NRHM Period 1 (1995–99) and pre-NRHM Period 2 (2000–04), but thereafter demonstrated steeper decline in post-NRHM periods. Uptake of institutional delivery increased among all socioeconomic groups, with (1) greater effects among the lowest and middle wealth and education tertiles than highest tertile, and (2) larger equity impacts in the late post-NRHM period 2011–12 than in the early post-NRHM period 2007–08. No positive impact on the uptake of ANC was found in the early post-NRHM period 2007–08; however, there was considerable increase in the uptake of, and decline in inequity, in uptake of ANC in most states in the late post-NRHM period 2011–12.

Conclusion: In high-focus states, NRHM resulted in increased uptake of maternal healthcare, and decline in its socioeconomic inequity. Our study suggests that public health programs in developing country settings will have larger equity impacts after its almost full implementation and widest outreach. Targeting deprived populations and designing public health programs by linking maternal and child healthcare components are critical for universal access to healthcare.
0268-1080
1-12
Vellakkal, Sukumar
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Gupta, Adyya
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Khan, Zaky
853dabb6-598f-48a9-8f81-b9c74fb11c29
Stuckler, David
99c8b899-5f71-420a-a81f-d034879cfb21
Reeves, Aaron
8635e61d-6dae-44e3-a8e9-ceeaa7d71b79
Ebrahim, Shah
0f2ade5c-4ef6-4ca7-9f9b-9b60ba192b13
Bowling, Ann
796ca209-687f-4079-8a40-572076251936
Doyle, Pat
dd5e23b7-6828-4d6e-a06b-c4957b3e8921
Vellakkal, Sukumar
abf4b500-11ff-4061-8ec2-da5b48d1c017
Gupta, Adyya
71d36909-6197-4864-b2a2-86592822c2ff
Khan, Zaky
853dabb6-598f-48a9-8f81-b9c74fb11c29
Stuckler, David
99c8b899-5f71-420a-a81f-d034879cfb21
Reeves, Aaron
8635e61d-6dae-44e3-a8e9-ceeaa7d71b79
Ebrahim, Shah
0f2ade5c-4ef6-4ca7-9f9b-9b60ba192b13
Bowling, Ann
796ca209-687f-4079-8a40-572076251936
Doyle, Pat
dd5e23b7-6828-4d6e-a06b-c4957b3e8921

Vellakkal, Sukumar, Gupta, Adyya, Khan, Zaky, Stuckler, David, Reeves, Aaron, Ebrahim, Shah, Bowling, Ann and Doyle, Pat (2016) Has India’s national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study. Health Policy and Planning, 1-12. (doi:10.1093/heapol/czw100).

Record type: Article

Abstract

Background: In 2005, India launched the National Rural Health Mission (NRHM) to strengthen the primary healthcare system. NRHM also aims to encourage pregnant women, particularly of low socioeconomic backgrounds, to use institutional maternal healthcare. We evaluated the impacts of NRHM on socioeconomic inequities in the uptake of institutional delivery and antenatal care (ANC) across high-focus (deprived) Indian states.

Methods: Data from District Level Household and Facility Surveys (DLHS) Rounds 1 (1995–99) and 2 (2000–04) from the pre-NRHM period, and Round 3 (2007–08), Round 4 and Annual Health Survey (2011–12) from post-NRHM period were used. Wealth-related and education-related relative indexes of inequality, and pre-post difference-in-differences models for wealth and education tertiles, adjusted for maternal age, rural-urban, caste, parity and state-level fixed effects, were estimated.

Results: Inequities in institutional delivery declined between pre-NRHM Period 1 (1995–99) and pre-NRHM Period 2 (2000–04), but thereafter demonstrated steeper decline in post-NRHM periods. Uptake of institutional delivery increased among all socioeconomic groups, with (1) greater effects among the lowest and middle wealth and education tertiles than highest tertile, and (2) larger equity impacts in the late post-NRHM period 2011–12 than in the early post-NRHM period 2007–08. No positive impact on the uptake of ANC was found in the early post-NRHM period 2007–08; however, there was considerable increase in the uptake of, and decline in inequity, in uptake of ANC in most states in the late post-NRHM period 2011–12.

Conclusion: In high-focus states, NRHM resulted in increased uptake of maternal healthcare, and decline in its socioeconomic inequity. Our study suggests that public health programs in developing country settings will have larger equity impacts after its almost full implementation and widest outreach. Targeting deprived populations and designing public health programs by linking maternal and child healthcare components are critical for universal access to healthcare.

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Accepted/In Press date: 4 July 2016
e-pub ahead of print date: 10 August 2016
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 399712
URI: http://eprints.soton.ac.uk/id/eprint/399712
ISSN: 0268-1080
PURE UUID: 02ac276b-c61e-4139-8307-53e7d40a22c0

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Date deposited: 25 Aug 2016 09:36
Last modified: 15 Mar 2024 02:00

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Contributors

Author: Sukumar Vellakkal
Author: Adyya Gupta
Author: Zaky Khan
Author: David Stuckler
Author: Aaron Reeves
Author: Shah Ebrahim
Author: Ann Bowling
Author: Pat Doyle

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