Geographic Inequities in Coverage of Maternal and Child health Services in Haryana State of India

  • Shankar PrinjaEmail author
  • Deepak Balasubramanian
  • Atul Sharma
  • Rakesh Gupta
  • Saroj Kumar Rana
  • Rajesh Kumar


Introduction India aims to achieve universal health coverage, with a focus on equitable delivery of services. There is significant evidence on extent of inequities by income status, gender and caste. In this paper, we report geographic inequities in coverage of reproductive, maternal and child health (MCH) services in Haryana state of India. Methods Cross-sectional data on utilization of maternal, child health and family planning services were collected from 12,191 women who had delivered a child in the last one year, 10314 women with 12–23 months old child, and 45864 eligible couples across all districts in Haryana state. Service coverage was assessed based on eight indicators − 6 for maternal health, one for child health and one for family planning. Inter- and intra-district inequalities were compared based on four and three indicators respectively. Results Difference in coverage of full ante-natal care, full immunization and contraceptive prevalence rate between districts performing best and worst was found to be 54%, 65% and 63% respectively. More than one-thirds of the sub-centres (SCs) in Panchkula, Ambala, Gurgaon and Mewat districts had their ante-natal care coverage less than 50% of the respective district average. Similarly, a significant proportion of SCs in Mewat, Panipat and Hisar districts had full immunization rate below 50% of the district average. Conclusion Widespread inter- and intra-district inequities in utilization of MCH services exist. A comprehensive geographical targeting to identify poor performing districts, community development blocks and SCs could result in significant equity gains, besides contributing to quick achievement of sustainable development goals.


Maternal and child health Family planning Healthcare services coverage Geographic inequities Inter-district inequities Intra-district inequities 



The study was funded by the National Rural Health Mission, Department of Health and Family Welfare, Government of Haryana. The funding agency had no role in the study design, collection of data, analysis or report writing.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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  1. Garg, S., & Nath, A. (2007). Current status of national rural health mission. Indian Journal of Community Medicine, 32(3), 171–172.CrossRefGoogle Scholar
  2. Gupta, M., Thakur, J. S., & Kumar, R. (2008). Reproductive and child health inequities in Chandigarh union territory of India. Journal of Urban Health, 85(2), 291–299. Scholar
  3. International Institute of Population Sciences. (2008). National Family Health Survey (NFHS-3), India, 2005-06: Haryana. Retrieved from Mumbai.Google Scholar
  4. Kieny, M. P., & Evans, D. B. (2013). Universal health coverage. Eastern Mediterranean Health Journal, 19(4), 305–306.CrossRefGoogle Scholar
  5. Kumar, A., & Mohanty, S. K. (2011). Intra-urban differentials in the utilization of reproductive healthcare in India, 1992–2006. Journal of Urban Health, 88(2), 311–328. Scholar
  6. Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365(9464), 1099–1104. Scholar
  7. Mathew, J. L. (2012). Inequity in childhood immunization in India: A systematic review. Indian Pediatrics, 49(3), 203–223.CrossRefGoogle Scholar
  8. Ministry of Health & Family Welfare. (2005). Report of the national commission on macroeconomics and health. New Delhi: MoHFW, Government of India.Google Scholar
  9. Ministry of Health & Family Welfare. (2009). National health accounts India 2004–05. New Delhi: National Health Accounts Cell, Ministry of Health and Family Welfare, Government of India.Google Scholar
  10. Ministry of Statistics and Programme Implementation. (2015). Per Capita National Income [Press release]. Retrieved from
  11. National Rural Health Mission. (2014). Report on rural health statistics upto 31st March, 2014. Panchkula: NRHMGoogle Scholar
  12. Navaneetham, K., & Dharmalingam, A. (2002). Utilization of maternal health care services in Southern India. Social Science & Medicine, 55(10), 1849–1869.CrossRefGoogle Scholar
  13. Office of the Registrar General and Census Commissioner. (2012). Census of India 2011. New Delhi: Ministry of Home Affairs. Government of India.Google Scholar
  14. Office of the Registrar General and Census Commissioner. (2014). SRS bulletin (vol 49(1)). New Delhi: Ministry of Home Affairs, Government of India.Google Scholar
  15. Prasad, A. M., Chakraborty, G., Yadav, S. S., & Bhatia, S. (2013). Addressing the social determinants of health through health system strengthening and inter-sectoral convergence: The case of the Indian National rural health mission. Global Health Action. 6, 20135. Scholar
  16. Prinja, S., Bahuguna, P., Gupta, R., Sharma, A., Rana, S. K., & Kumar, R. (2015). Coverage and financial risk protection for institutional delivery: How universal is provision of maternal health care in India? PLoS ONE. 10(9), e0137315. Scholar
  17. Prinja, S., Bahuguna, P., Pinto, A. D., Sharma, A., Bharaj, G., Kumar, V., et al. (2012). The cost of universal health care in India: A model based estimate. PLoS ONE. 7(1), e30362. Scholar
  18. Prinja, S., Gupta, R., Bahuguna, P., Sharma, A., Aggarwal, A. K., Phogat, A., & Kumar, R. (2016). A composite indicator to measure universal health care coverage in India: Way forward for post-2015 health system performance monitoring framework. Health Policy Planning. Scholar
  19. Prinja, S., Kanavos, P., & Kumar, R. (2012). Health care inequities in north India: Role of public sector in universalizing health care. The Indian Journal of Medical Research, 136(3), 421–431.Google Scholar
  20. Purohit, B. C. (2004). Inter-state disparities in health care and financial burden on the poor in India. Journal of Health & Social Policy, 18(3), 37–60. Scholar
  21. Rani, M., Bonu, S., & Harvey, S. (2008). Differentials in the quality of antenatal care in India. International Journal for Quality in Health Care, 20(1), 62–71.CrossRefGoogle Scholar
  22. Sanneving, L., Trygg, N., Saxena, D., Mavalankar, D., & Thomsen, S. (2013). Inequity in India: The case of maternal and reproductive health. Global Health Action, 6, 19145. Scholar
  23. Sharma, A., Rana, S. K., Prinja, S., & Kumar, R. (2016). Quality evaluation of health management information system for maternal & child health care in Haryana state, India. PLoS ONE. 11(2), e0148449. Scholar
  24. Sikander, M. U., & Shah, S. A. A. (2010). Inter-district inequalities in social service delivery: A rationalised approach towards funds disbursement. Pakistan Development Review, 49, 881–899.CrossRefGoogle Scholar
  25. Suryanarayana, M. H., Agrawal, A., & Prabhu, K. S. (2011). Inequality adjusted human development index for India’s States. New Delhi: United Nations Development Programme.Google Scholar
  26. Tandon, A., & Cashin, C. (2010). Assessing public expenditure on health from a fiscal space perspective. Health, nutrition and population (HNP). Washington, DC: The International Bank for Reconstruction and Development/The World Bank.Google Scholar
  27. Thomsen, S., Hoa, D. T., Malqvist, M., Sanneving, L., Saxena, D., Tana, S., et al. (2011). Promoting equity to achieve maternal and child health. Reproductive Health Matters, 19(38), 176–182. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Shankar Prinja
    • 1
    Email author
  • Deepak Balasubramanian
    • 1
  • Atul Sharma
    • 1
  • Rakesh Gupta
    • 2
  • Saroj Kumar Rana
    • 1
  • Rajesh Kumar
    • 1
  1. 1.School of Public HealthPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of Health and Family WelfareNational Rural Health MissionPanchkulaIndia

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