Maternal and Child Health in Districts of India: Deprivation and Disparities

  • Basant Kumar Panda
  • Udaya S. Mishra
  • Shubhkant Swain


Attaining health-related Sustainable Development Goals (SDGs) requires compliance with the continuum of four basic maternal and child (MCH) cares, antenatal care (ANC), skilled birth attendance (SBA), postnatal care (PNC) and child immunization. The progress in these maternal and child health services is uneven and large across geographies, economic and social classes in states of India. Little is known on extent of inequality in these services in districts of India. An assessment of disparities and inter-dependence across these four milestones of MCH care in the districts of India would be helpful for effective planning and programme implementation. At the same time, the extent of deprivation from the ideal of full compliance on all four fronts situates the study of inter-regional differences. Using the recent round of data from National Family and Health Survey 4, this paper examines the state of maternal and child health across 640 districts in India. A composite index of MCH care based on antenatal care, skilled birth attendance, postnatal care and child immunization is computed and compared across the districts of India and districts within each state. A deprivation index is computed to understand the shortfall in MCH care.

Results suggest that there is considerable inter district variation in maternal and child health across the districts. The MCH index in India, found to be 0.43, varies from Mon district of Nagaland to Kapurthala district of Punjab. Out of 640 districts, 238 districts had MCH index less than 0.4, 235 districts between 0.4 and 0.6 and 122 districts higher than 0.6. Similarly, the deprivation score in India shows enormous variations among the districts. A total of 391 districts had a deprivation score of 1.5 and more. The present pattern of MCH care infers large disparity in MCH care among districts. Reduction of inequality in MCH care is important for achieving Sustainable Development Goals.

Understanding the pattern of MCH at the district level is of considerable relevance for evolving policies and programme interventions. Targeted interventions in high-focussed districts can reduce interdistrict disparity in maternal and child healthcare in India.


Maternal and child health Disparity Deprivation distance Interdependence India Districts 


  1. Achia, T. N. O., & Mageto, L. E. (2015). Individual and contextual determinants of adequate maternal health care services in Kenya. Women & Health, 55(2), 203–226.CrossRefGoogle Scholar
  2. Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A.-B., Gemmill, A., Fat, D.M., Boerma, T., Temmerman, M., & Mathers, C. (2016). Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet, 387(10017), 462–474.Google Scholar
  3. Awasthi, A., Pandey, C. M., Chauhan, R. K., & Singh, U. (2016). Disparity in maternal, newborn and child health services in high focus states in India: A district-level cross-sectional analysis. BMJ Open, 6(8), e009885.CrossRefGoogle Scholar
  4. Barros, A. J. D., & Victora, C. G. (2013). Measuring coverage in MNCH: Determining and interpreting inequalities in coverage of maternal, newborn, and child health interventions. PLoS Medicine, 10(5), e1001390.CrossRefGoogle Scholar
  5. Fadel, S. A., Ram, U., Morris, S. K., Begum, R., Shet, A., Jotkar, R., & Jha, P. (2015). Facility delivery, postnatal care and neonatal deaths in India: Nationally-representative case-control studies. PLoS One, 10(10), e0140448.CrossRefGoogle Scholar
  6. Guilmoto, C. Z., Saikia, N., Tamrakar, V., & Bora, J. K. (2018). Excess under-5 female mortality across India: A spatial analysis using 2011 census data. The Lancet Global Health, 6(6), e650–e658.CrossRefGoogle Scholar
  7. Heredia-Pi, I., Servan-Mori, E., Darney, B. G., Reyes-Morales, H., & Lozano, R. (2016). Measuring the adequacy of antenatal health care: A national cross-sectional study in Mexico. Bulletin of the World Health Organization, 94(6), 452.CrossRefGoogle Scholar
  8. Hug, L., Sharrow, D., You, D. (2017). Levels & trends in child mortality: Report 2017. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation.Google Scholar
  9. International Institute for Population Sciences and ICF. (2017). India National Family Health Survey (NFHS-4), 2015–16. Mumbai: International Institute for Population Sciences.Google Scholar
  10. Joe, W., Perkins, J. M., Kumar, S., Rajpal, S., & Subramanian, S. V. (2018). Institutional delivery in India, 2004–14: Unravelling the equity-enhancing contributions of the public sector. Health Policy and Planning, 33(5), 645–653.CrossRefGoogle Scholar
  11. Kumar, A., & Mohanty, S. K. (2011). Socio-economic differentials in childhood immunization in India, 1992–2006. Journal of Population Research, 28(4), 301.CrossRefGoogle Scholar
  12. Kumar, C., Singh, P. K., & Rai, R. K. (2012). Under-five mortality in high focus states in India: A district level geospatial analysis. PLoS One, 7(5), e37515.CrossRefGoogle Scholar
  13. Kuruvilla, S., Schweitzer, J., Bishai, D., Chowdhury, S., Caramani, D., Frost, L., & Adam, T. (2014). Success factors for reducing maternal and child mortality. Bulletin of the World Health Organization, 92, 533–544.CrossRefGoogle Scholar
  14. Lauridsen, J., & Pradhan, J. (2011). Socio-economic inequality of immunization coverage in India. Health Economics Review, 1(1), 11.CrossRefGoogle Scholar
  15. Lee, H.-Y., Van Do, D., Choi, S., Trinh, O. T. H., & To, K. G. (2016). Trends and determinants of infant and under-five childhood mortality in Vietnam, 1986–2011. Global Health Action, 9(1), 29312.CrossRefGoogle Scholar
  16. Madaj, B., Smith, H., Mathai, M., Roos, N., & van den Broek, N. (2017). Developing global indicators for quality of maternal and newborn care: A feasibility assessment. Bulletin of the World Health Organization, 95(6), 445.CrossRefGoogle Scholar
  17. Ministry of Statistics and Programme Implementation. (2015). Millennium development goals India country report 2015. New Delhi: Government of India.Google Scholar
  18. Mohanty, S. K. (2011). Multidimensional poverty and child survival in India. PLoS One, 6(10), e26857.CrossRefGoogle Scholar
  19. Mohanty, S. K. (2012). Multiple deprivations and maternal care in India. International Perspectives on Sexual and Reproductive Health, 38, 6–14.CrossRefGoogle Scholar
  20. Mohanty, S. K., & Kastor, A. (2017). Out-of-pocket expenditure and catastrophic health spending on maternal care in public and private health centres in India: A comparative study of pre and post national health mission period. Health Economics Review, 7(1), 31.CrossRefGoogle Scholar
  21. Mohanty, S. K., Fink, G., Chauhan, R. K., & Canning, D. (2016). Distal determinants of fertility decline: Evidence from 640 Indian districts. Demographic Research, 34, 373–406.CrossRefGoogle Scholar
  22. Office of the Registrar General of India (ORGI). (2018). Special bulletin on maternal mortality in India 2014–16. Registrar General of India. New Delhi.Google Scholar
  23. Planning Commission. (2014). Report of the expert group to review the methodology for measurement of poverty. New Delhi: Government of India.Google Scholar
  24. Prusty, R. K., & Kumar, A. (2014). Socioeconomic dynamics of gender disparity in childhood immunization in India, 1992–2006. PLoS One, 9(8), e104598.CrossRefGoogle Scholar
  25. Singh, A. (2012). Gender based within-household inequality in childhood immunization in India: Changes over time and across regions. PLoS One, 7(4), e35045.CrossRefGoogle Scholar
  26. Singh, A., Padmadas, S. S., Mishra, U. S., Pallikadavath, S., Johnson, F. A., & Matthews, Z. (2012). Socio-economic inequalities in the use of postnatal care in India. PLoS One, 7(5), e37037.CrossRefGoogle Scholar
  27. Singh, A., Pallikadavath, S., Ram, F., & Alagarajan, M. (2013). Do antenatal care interventions improve neonatal survival in India? Health Policy and Planning, 29(7), 842–848.CrossRefGoogle Scholar
  28. Subramanian, S. (2008). On a ‘Level-Sensitive ‘Headcount Ratio: Revisiting Shorrocks’ poverty index. Social Indicators Research, 88(3), 477–482.CrossRefGoogle Scholar
  29. United Nation. (2016). Report of the inter-agency and expert group on sustainable development goal indicators. (E/CN.3/2016/2/Rev.1).Google Scholar
  30. Van den Broek, N. R., & Graham, W. J. (2009). Quality of care for maternal and newborn health: The neglected agenda. BJOG: An International Journal of Obstetrics & Gynaecology, 116(s1), 18–21.CrossRefGoogle Scholar
  31. Victora, C., Requejo, J., Boerma, T., Amouzou, A., Bhutta, Z. A., Black, R. E., & Chopra, M. (2016). Countdown to 2030 for reproductive, maternal, newborn, child, and adolescent health and nutrition. The Lancet Global Health, 4(11), e775–e776.CrossRefGoogle Scholar
  32. Wagstaff, A., Paci, P., & Van Doorslaer, E. (1991). On the measurement of inequalities in health. Social Science & Medicine, 33(5), 545–557.CrossRefGoogle Scholar
  33. World Health Organization. (2016). World health statistics 2016: Monitoring health for the SDGs sustainable development goals. World Health Organization.
  34. You, D., Hug, L., Ejdemyr, S., Beise, J. (2015). Levels and trends in child mortality. Report 2015. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Basant Kumar Panda
    • 1
  • Udaya S. Mishra
    • 2
  • Shubhkant Swain
    • 3
  1. 1.International Institute for Population SciencesMumbaiIndia
  2. 2.Centre for Development StudiesThiruvananthapuramIndia
  3. 3.Tata-Cornell Institute for Agriculture and Nutrition (TCI)Cornell UniversityIthacaUSA

Personalised recommendations