Abstract
Despite the colossal rise in institutional delivery (from 20% in 2005–2006 to 64% in 2015–2016), the state of Bihar shows the poorest performance in the country for utilization of four or more antenatal care services (4 or more ANCs) (14%). In this background, the present paper aims to investigate the factors associated with the low uptake of ANCs in Bihar, India. The study analyses a sample of 16,822 women aged 15–49 in Bihar from the fourth round of the National Family Health Survey (NFHS-4) conducted during 2015–2016. Bivariate and multivariate logistic and linear regression analyses are employed to identify the factors associated with the underutilization of 4 or more ANCs in Bihar. Five out of 38 districts of Bihar have more than 20% uptake of 4 or more ANCs while 13 districts have only 7 to 12% of uptake. However, 79% of women had institutional delivery without having 4 or more ANCs. The results from the logistic regression model suggest that mothers who belonged to the richest wealth index (OR = 3.90; 99% CI: 2.98–5.08) and a higher level of education (OR = 3.35; 99% CI: 2.74–4.08) have a greater likelihood of receiving 4 or more ANCs. In order of their importance, focusing on economic, education, and caste inequalities, awareness of pregnancy registration with MCP cards, and avoiding higher-order births are likely to improve the uptake of 4 or more ANCs in Bihar.
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The first author lodged a request application via the online Demographic and Health Surveys program to use NFHS data (2015–2016) for this study. The dataset is available at https://dhsprogram.com/data/dataset/India_Standard-DHS_2015.cfm?flag=0
Notes
Post-JSY here refers to the 10-year period after JSY was launched in 2005.
References
Adhikari T, Sahu D, Nair S, Saha KB, Sharma RK, Pandey A (2016) Factors associated with utilization of antenatal care services among tribal women: A study of selected states. Indian J Med Res 144(1):58–66. https://doi.org/10.4103/0971-5916.193284
Ali B, Chauhan S (2020) Inequalities in the utilisation of maternal health care in Rural India: evidences from national family health survey III & IV. BMC Public Health 20(1):369. https://doi.org/10.1186/s12889-020-08480-4
Ali B, Dhillon P, Mohanty SK (2020) Inequalities in the utilization of maternal health care in the pre- and post-national health mission periods in India. J Biosoc Sci 52(2):198–212. https://doi.org/10.1017/S0021932019000385
Andrade MV, Noronha K, Singh A, Rodrigues CG, Padmadas SS (2012) Antenatal care use in Brazil and India: scale, outreach and socioeconomic inequality. Health Place 18(5):942–950. https://doi.org/10.1016/j.healthplace.2012.06.014
Arokiasamy P, Pradhan J (2013) Maternal health care in India: access and demand determinants. Primary Health Care Res Dev 14(4):373–393. https://doi.org/10.1017/S1463423612000552
Baru R, Acharya A, Acharya S, Kumar AKS, Nagaraj K (2010) Inequities in access to health services in india: caste, class and region. Econ Pol Wkly 45(38):49–58
Bhatia JC, Cleland J (1995) Determinants of maternal care in a region of South India. Health Trans Rev 5(2):127–142
Bhattacharyya S, Srivastava A, Roy R, Avan BI (2016) Factors influencing women’s preference for health facility deliveries in Jharkhand state, India: a cross sectional analysis. BMC Pregnancy Childbirth 16(1):1–9. https://doi.org/10.1186/s12884-016-0839-6
ESDPD. (2018). Directorate of Economics and Statistics. http://www.dse.bih.nic.in/
GBD 2015 Maternal Mortality Collaborators. (2016). Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1775–1812. https://doi.org/10.1016/S0140-6736(16)31470-2
Germain A, Sen G, Garcia-Moreno C, Shankar M (2015) Advancing sexual and reproductive health and rights in low- and middle-income countries: implications for the post-2015 global development agenda. Glob Public Health 10(2):137–148. https://doi.org/10.1080/17441692.2014.986177
Goli S, James KS, Pallikadavath S, Mishra US, Rajan SI, Prasad RD, Salve PS (2020) Perplexing condition of child full immunisation in economically better off Gujarat in India: an assessment of associated factors. Vaccine 38(36):5831–5841. https://doi.org/10.1016/j.vaccine.2020.06.041
Government of Bihar. (2020). Bihar Economic Survey-2019–20. http://finance.bih.nic.in/Reports/Economic-Survey-2020-EN.pdf
Government of India. (2005). Janani Suraksha Yojana: Guidelines for Implementation. http://www.ilo.org/dyn/travail/docs/683/JananiSurakshaYojanaGuidelines/MinistryofHealthandFamilyWelfare.pdf
Government of India. (2017). Pradhan Mantri Matru Vandana Yojana (PMMVY). https://wcd.nic.in/sites/default/files/PMMVY Scheme Implementation Guidelines ._0.pdf
IIPS and ICF. (2017). National Family Health Survey (NFHS-4), 2015–16: India. Ministry of Health and Family Welfare, Government of India.
IIPS and ORC Macro. (2007). National Family Health Survey (NFHS-3), 2005–06: India. Ministry of Health and Family Welfare, Government of India.
Jain AK (2011) Measuring the effect of fertility decline on the maternal mortality ratio. Stud Fam Plann 42(4):247–260. https://doi.org/10.1111/j.1728-4465.2011.00288.x
Joe W, Mishra US, Navaneetham K (2008) Health inequality in India: evidence from NFHS 3. Econ Political Weekly 43(31):41–47
Joshi C, Torvaldsen S, Hodgson R, Hayen A (2014) Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. BMC Pregnancy Childbirth 14(1):94. https://doi.org/10.1186/1471-2393-14-94
Jungari S, Chauhan BG (2017) Caste, wealth and regional inequalities in health status of women and children in India. Contemporary Voice of Dalit 9(1):87–100. https://doi.org/10.1177/2455328X17690644
Kesterton AJ, Cleland J, Sloggett A, Ronsmans C (2010) Institutional delivery in rural India: the relative importance of accessibility and economic status. BMC Pregnancy Childbirth 10:30. https://doi.org/10.1186/1471-2393-10-30
Kuhnt J, Vollmer S (2017) Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open 7(11):e017122. https://doi.org/10.1136/bmjopen-2017-017122
Lahariya C (2009) Cash incentives for institutional delivery: Linking with antenatal and post natal care may ensure “continuum of care” in India. Indian J Commun Med 34(1):15–18. https://doi.org/10.4103/0970-0218.45370
Laksono AD, Rukmini R, Wulandari RD (2020) Regional disparities in antenatal care utilization in Indonesia. PLoS ONE 15(2):e0224006. https://doi.org/10.1371/journal.pone.0224006
Lee HY, Oh J, Kim R, Subramanian SV (2020) Long-term trend in socioeconomic inequalities and geographic variation in the utilization of antenatal care service in India between 1998 and 2015. Health Serv Res 55(3):419–431. https://doi.org/10.1111/1475-6773.13277
Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E (2010) India’s janani suraksha yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. The Lancet 375(9730):2009–2023. https://doi.org/10.1016/S0140-6736(10)60744-1
Mohanty SK, Mishra US, Chauhan RK. (2019). The Demographic and Development Divide in India (1st ed.). Springer Nature Singapore Pte Ltd. https://doi.org/10.1007/978-981-13-5820-3
Mohanty S, Pathak P (2009) Rich-poor gap in utilization of reproductive and child health services in India, 1992–2005. J Biosoc Sci 41(3):381–98. https://doi.org/10.1017/S002193200800309X
Moller AB, Petzold M, Chou D, Say L (2017) Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013. Lancet Glob Health 5(10):e977–e983. https://doi.org/10.1016/S2214-109X(17)30325-X
Mukherjee S, Haddad S, Narayana D (2011) Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India. Int J Equity in Health. https://doi.org/10.1186/1475-9276-10-1
Navaneetham K, Dharmalingam A (2002) Utilization of maternal health care services in Southern India. Soc Sci Med 55(10):1849–1869. https://doi.org/10.1016/s0277-9536(01)00313-6
Office of the Registrar General of India. (2020). Special Bulletin on Maternal Mortality in India – 2016–18. https://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR Bulletin 2016–18.pdf
Onasoga OA, Afolayan JA, Oladimeij BD (2012) Factor’s influencing utilization of antenatal care services among pregnant women in Ife central LGA, osun state nigeria. Adv Appl Sci Res 3(3):1309–1315
Pallikadavath S, Foss M, Stones RW (2004) Antenatal care: provision and inequality in rural north India. Soc Sci Med 59(6):1147–1158. https://doi.org/10.1016/j.socscimed.2003.11.045
Pathak PK, Singh A, Subramanian SV (2010) Economic inequalities in maternal health care: prenatal care and skilled birth attendance in India, 1992–2006. PLoS ONE 5(10):e13593. https://doi.org/10.1371/journal.pone.0013593
Rai RK, Singh PK (2012) Janani suraksha yojana: the conditional cash transfer scheme to reduce maternal mortality in India – a need for reassessment. WHO South-East Asia J Pub Health 1(4):362–368
Rai RK, Singh PK, Singh L (2012) Utilization of maternal health care services among married adolescent women: insights from the nigeria demographic and health survey, 2008. Women’s Health Issues 22(4):e407–e414. https://doi.org/10.1016/j.whi.2012.05.001
Ramarao S, Celeb L, Khan ME, Townsend JW (2001) Safer maternal health in rural Uttar Pradesh: do primary health services contribute? Health Policy Plan 16(3):256–263. https://doi.org/10.1093/heapol/16.3.256
Randive B, Chaturvedi SD, Diwan V, Costa AD (2013) Effective coverage of institutional deliveries under the Janani Suraksha Yojana programme in high maternal mortality provinces of India: analysis of data from an annual health survey. The Lancet 381:S123. https://doi.org/10.1016/S0140-6736(13)61377-X
Rani M, Bonu S, Harvey S (2008) Differentials in the quality of antenatal care in India. Int J Qual Health Care 20(1):62–71. https://doi.org/10.1093/intqhc/mzm052
Registrar General of India. (2011). Population Enumeration Data (Final Population). https://censusindia.gov.in/2011census/population_enumeration.html
Retherford RD, Mishra VK (1997). Media exposure increases contraceptive use. National Family Health Survey Bulletin.
Sahoo J, Singh SV, Gupta VK, Garg S, Kishore J (2015) Do socio-demographic factors still predict the choice of place of delivery: a cross-sectional study in rural North India. J Epidemiol Global Health 5(4):S27-34. https://doi.org/10.1016/j.jegh.2015.05.002
Samadoulougou S, Sawadogo KC, Robert A (2018) Regional disparities of late entry to antenatal care and associated sociodemographic barriers in Burkina Faso. Revue D’épidémiologie Et De Santé Publique 66:S435. https://doi.org/10.1016/j.respe.2018.05.546
Sen S, Chatterjee S, Khan PK, Mohanty SK (2020) Unintended effects of janani suraksha yojana on maternal care in India. SSM - Population Health 11:100619. https://doi.org/10.1016/j.ssmph.2020.100619
Singh A, Padmadas SS, Mishra US, Pallikadavath S, Amoako Johnson F, Matthews Z (2012) Socio-economic inequalities in the use of postnatal care in India. PLoS ONE. https://doi.org/10.1371/journal.pone.0037037
Singh L, Rai RK, Singh PK (2012b) Assessing the utilization of maternal and child health care among married adolescent women: evidence from India. J Biosoc Sci 44(1):1–26. https://doi.org/10.1017/S0021932011000472
Singh PK, Rai RK, Alagarajan M, Singh L (2012c) Determinants of maternity care services utilization among married adolescents in rural India. PLoS ONE 7(2):e31666. https://doi.org/10.1371/journal.pone.0031666
Singh PK, Kumar C, Rai RK, Singh L (2014) Factors associated with maternal healthcare services utilization in nine high focus states in India: a multilevel analysis based on 14 385 communities in 292 districts. Health Policy Plan 29(5):542–559. https://doi.org/10.1093/heapol/czt039
Singh L, Dubey R, Singh S, Goel R, Nair S, Singh PK (2019) Measuring quality of antenatal care: a secondary analysis of national survey data from India. BJOG An Int J Obstetrics Gynaecol 126(S4):7–13. https://doi.org/10.1111/1471-0528.15825
Singh BK (2017). Spatial distribution of health care facilities in Bihar, India. Demography India, 46(2), 68–80. http://demographyindia.in/article_document/54/699526.pdf
Sunil TS, Rajaram S, Zottarelli LK (2006) Do individual and program factors matter in the utilization of maternal care services in rural India? A theoretical approach. Soc Sci Med 62(8):1943–1957. https://doi.org/10.1016/j.socscimed.2005.09.004
Titaley CR, Dibley MJ, Roberts CL (2010) Factors associated with underutilization of antenatal care services in Indonesia: results of indonesia demographic and health survey 2002/2003 and 2007. BMC Publ Health 16(10):485. https://doi.org/10.1186/1471-2458-10-485
Tunçalp Ӧ, Pena-Rosas JP, Lawrie T, Bucagu M, Oladapo OT, Portela A, Metin Gülmezoglu A (2017) WHO recommendations on antenatal care for a positive pregnancy experience—going beyond survival. BJOG An Int J Obstetrics Gynaecol 124(6):860–862. https://doi.org/10.1111/1471-0528.14599
UNICEF. (2019). Maternal Health in Focus: UNICEF India.
United Nations. (2018). The Sustainable Development Goals Report-2018.
Vellakkal S, Reddy H, Gupta A, Chandran A, Fledderjohann J, Stuckler D (2017) A qualitative study of factors impacting accessing of institutional delivery care in the context of India’s cash incentive program. Soc Sci Med 178:55–65. https://doi.org/10.1016/j.socscimed.2017.01.059
WHO. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/
Acknowledgements
The work was supported by the Department of Biotechnology (DBT), India, and Medical Research Council (MCR), UK (PAC-SSS-KSJ-DBT-03180321-1114). The final decisions on the study design, analysis, the decision to publish, and the content of the manuscript were made by the University-based researchers. The funding bodies had no role in study design, data collection, and analysis.
Funding
The work was supported by the Department of Biotechnology (DBT), India, and the Medical Research Council (MCR), UK. The final decisions on the study design, analysis, the decision to publish, and the content of the manuscript were made by the University-based researchers. The funding bodies had no role in study design, data collection, and analysis.
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Prasad, R.D., Arora, S., Salve, P.S. et al. Why there is underutilization of four and more antenatal care services despite the colossal rise in institutional deliveries in Bihar, India. J. Soc. Econ. Dev. 24, 355–378 (2022). https://doi.org/10.1007/s40847-022-00205-0
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DOI: https://doi.org/10.1007/s40847-022-00205-0