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Coverage of Quality Maternal and Newborn Healthcare Services in India: Examining Dropouts, Disparity and Determinants Cover

Coverage of Quality Maternal and Newborn Healthcare Services in India: Examining Dropouts, Disparity and Determinants

Annals of Global Health
Volume 88 (2022): Issue 1
By: Lucky Singh,  Ritam Dubey,  Prashant Kumar Singh,  Saritha Nair,  Rajesh Kumar Rai,  M. Vishnu Vardhana Rao and  Shalini Singh  
Open Access
|May 2022
Figures & tables

Figures & Tables

Figure 1

Utilization of quality maternal and newborn healthcare services and its components along the continuum of care at the national level (2015–16).

Figure 2

Utilization of quality maternal and newborn healthcare services and its components along the continuum of care in rural India (2015–16).

Figure 3

Utilization of quality maternal and newborn healthcare services and its components along the continuum of care in urban India (2015–16).

Figure 4

State-wise utilization of quality maternal and newborn healthcare services along the continuum of care (in%).

Table 1

Urban-rural differentials observed among women with regards to quality Maternal and Newborn care as captured by NFHS-4 (2015–16).

STATESQUALITY ANCQUALITY DELIVERY CAREQUALITY PNC
RURALURBANU VS RRURALURBANU VS RRURALURBANU VS R
Andaman and Nicobar islands62.5[57.2,67.6]50.9[37.5,64.2]–18.694.4[90.5,96.8]98.0[92.8,99.4]3.821.9[16.5,28.5]22.2[11.5,38.4]1.4
Andhra Pradesh43.2[40.2,46.3]45.0[40.7,49.5]4.287.7[85.2,89.9]93.8[91.0,95.8]7.026.1[23.5,28.9]30.0[25.4,35.1]14.9
Arunachal Pradesh8.6[7.2,10.3]11.0[8.3,14.5]27.946.2[42.9,49.5]82.1[77.5,85.9]77.77.9[6.5,9.7]5.7[4.0,8.1]–27.8
Assam22.0[20.5,23.6]34.9[30.3,39.9]58.670.4[68.4,72.3]92.7[89.6,95.0]31.722.0[20.4,23.6]23.8[19.9,28.2]8.2
Bihar2.8[2.5,3.1]5.9[4.5,7.7]110.762.7[61.4,64.0]76.3[73.0,79.4]21.79.4[8.7,10.2]16.1[13.4,19.1]71.3
Chandigarh33.3[33.3,33.3]38.0[28.4,48.7]14.1100.0*92.4[85.8,96.1]–7.666.7[66.7,66.7]49.8[38.5,61.2]–25.3
Chhattisgarh28.9[26.7,31.3]42.8[38.4,47.4]48.168.7[66.5,70.9]84.4[80.8,87.4]22.930.1[27.9,32.5]38.9[34.7,43.3]29.2
Dadra and Nagar Haveli46.4[32.2,61.2]18.3[11.4,28.0]–60.685.7[73.9,92.7]93.2[85.6,96.9]8.824.7[14.9,38.1]12.7[5.8,25.7]–48.6
Daman and Diu40.4[27.6,54.6]32.5[24.6,41.7]–19.681.9[69.5,90.0]75.5[67.4,82.1]–7.823.5[14.9,35.2]15.2[9.4,23.6]–35.3
Goa57.0[48.4,65.2]67.9[59.1,75.6]19.198.6[95.7,99.5]97.0[93.4,98.7]–1.647.2[37.0,57.7]48.2[41.3,55.1]2.1
Gujarat31.0[28.8,33.3]46.7[42.1,51.4]50.682.0[79.9,83.9]91.9[89.9,93.5]12.113.4[11.7,15.4]14.7[11.4,18.6]9.7
Haryana26.4[24.1,28.7]27.3[24.1,30.7]3.482.4[80.7,84.0]80.9[77.7,83.8]–1.821.3[19.2,23.6]18.6[15.8,21.8]–12.7
Himachal Pradesh33.3[30.7,36.0]47.6[37.7,57.8]42.975.7[72.7,78.5]91.3[84.4,95.3]20.627.8[25.0,30.8]35.9[27.0,46.0]29.1
Jammu and Kashmir33.4[31.1,35.7]42.2[36.5,48.1]26.382.5[80.7,84.1]97.4[95.9,98.3]18.117.1[15.5,18.8]25.9[20.4,32.2]51.5
Jharkhand9.4[8.4,10.5]18.6[16.0,21.7]97.958.7[56.8,60.5]83.2[80.6,85.4]41.720.1[18.5,21.8]23.2[20.1,26.7]15.4
Karnataka35.0[32.1,38.0]34.5[29.6,39.8]–1.491.2[89.9,92.3]90.8[87.3,93.4]–0.421.8[19.7,24.0]20.0[16.2,24.4]–8.3
Kerala55.5[51.9,59.0]56.7[52.1,61.2]2.2100.0[99.9,100.0]99.8[99.1,99.9]–0.249.8[45.7,54.0]47.4[42.8,51.9]–4.8
Lakshadweep61.8[40.6,79.2]63.5[54.9,71.4]2.894.6[69.6,99.3]100.05.760.6[54.5,66.3]56.2[48.5,63.5]–7.3
Madhya Pradesh10.7[9.9,11.5]23.1[20.7,25.8]115.972.5[71.2,73.7]89.9[88.2,91.3]24.015.6[14.5,16.6]18.2[16.4,20.2]16.7
Maharashtra31.2[29.0,33.4]35.7[31.5,40.1]14.484.7[82.7,86.5]93.8[92.2,95.1]10.729.2[27.2,31.3]28.4[24.5,32.6]–2.7
Manipur22.1[19.6,24.7]32.1[27.7,36.8]45.264.3[61.3,67.1]87.3[84.5,89.7]35.88.3[6.7,10.3]14.3[11.5,17.7]72.3
Meghalaya19.3[16.8,22.1]35.3[29.2,41.9]82.948.6[44.5,52.7]89.7[85.7,92.6]84.67.3[5.8,9.1]14.5[9.9,20.8]98.6
Mizoram18.8[15.6,22.4]36.1[32.4,39.9]92.062.8[58.0,67.4]98.0[97.1,98.6]56.16.8[4.8,9.6]12.6[9.9,16.0]85.3
Nagaland1.4[1.0,2.1]4.9[3.6,6.6]250.026.5[23.9,29.3]56.8[52.3,61.1]114.31.2[0.8,1.8]2.1[1.1,4.0]75.0
Delhi29.7[22.6,38.0]32.8[29.0,36.7]10.480.2[57.4,92.4]85.8[82.5,88.5]7.019.8[7.6,42.6]20.1[15.6,25.6]1.5
Odisha26.8[25.4,28.3]32.6[28.6,36.8]21.683.6[82.2,84.8]88.2[81.1,92.8]5.529.0[27.5,30.6]23.7[20.2,27.5]–18.3
Puducherry46.4[36.8,56.3]65.5[55.8,74.1]41.2100.099.8[99.2,100.0]–0.236.8[28.7,45.8]32.1[22.6,43.4]–12.8
Punjab37.5[34.5,40.6]40.5[36.5,44.6]8.092.0[90.5,93.3]89.8[85.5,93.0]–2.445.8[42.7,49.0]44.7[39.9,49.6]–2.4
Rajasthan15.2[14.1,16.4]28.2[25.7,30.7]85.583.3[82.1,84.5]91.2[89.7,92.5]9.521.2[19.8,22.7]23.7[21.2,26.5]11.8
Sikkim52.9[48.2,57.6]57.3[49.7,64.6]8.394.8[92.2,96.6]95.4[91.3,97.6]0.613.5[9.7,18.4]9.5[5.5,15.7]–29.6
Tamil Nadu40.9[38.2,43.6]42.9[39.5,46.3]4.998.7[97.8,99.2]99.1[98.6,99.5]0.432.5[30.1,35.0]31.8[29.1,34.6]–2.2
Tripura17.0[13.9,20.7]27.4[21.2,34.7]61.278.6[75.1,81.8]93.1[87.7,96.2]18.48.6[6.2,11.6]6.9[3.8,12.1]–19.8
Uttar Pradesh4.6[4.3,5.0]16.8[15.4,18.3]265.266.9[65.9,67.8]73.1[71.3,74.7]9.321.5[20.6,22.4]31.6[29.6,33.8]47.0
Uttarakhand9.2[7.9,10.7]16.1[13.1,19.7]75.064.7[62.1,67.3]79.8[76.0,83.1]23.315.8[13.9,17.8]22.9[18.9,27.4]44.9
West Bengal28.4[26.1,30.9]32.4[28.3,36.9]14.173.5[70.8,76.0]85.0[79.7,89.1]15.625.1[23.0,27.3]25.3[21.5,29.5]0.8
Telangana37.9[34.5,41.4]42.7[37.1,48.6]12.784.8[82.2,87.0]93.8[91.5,95.6]10.627.7[24.5,31.0]21.2[16.9,26.3]–23.5
Total19.5[19.1,19.9]32.9[31.9,33.9]68.775.2[74.8,75.6]88.5[87.9,89.1]17.721.8[21.4,22.2]26.1[25.2,27.0]19.7

[i] * Small sample size obtained from Chandigarh (n = 6).

Figure 5

Spatial variation for utilization of quality ANC across 640 districts of India, 2015–16.

Figure 6

Spatial variation for utilization of quality delivery care across 640 districts of India, 2015–16.

Figure 7

Spatial variation for utilization of quality PNC across 640 districts of India, 2015–16.

Table 2

Socioeconomic differentials observed among women with regards to quality ANC accessed as captured by NFHS-4 (2015–16).

BACKGROUND VARIABLESNO ANCINADEQUATE ANCADEQUATE ANC
%95% CI%95% CI%95% CI
Mother’s age at child birthχ2 = 138.1; p = <0.01
less than 19 (n = 13,849)15.4[14.6,16.3]62.1[60.8,63.3]22.5[21.4,23.6]
20–24 (n = 75,353)15.1[14.7,15.5]60.4[59.7,61.0]24.6[24.0,25.2]
25–29 (n = 62,536)17.5[17.1,18.0]58.2[57.6,58.9]24.3[23.7,24.8]
30–34 (n = 26,772)22.0[21.2,22.7]55.9[54.9,56.8]22.2[21.3,23.1]
35–39 (n = 9,412)30.2[28.8,31.6]53.8[52.2,55.4]15.9[14.7,17.2]
40–49 (n = 2,976)44.6[42.1,47.1]44.9[42.5,47.4]10.5[8.9,12.3]
Women’s educationχ2 = 902.3; p = <0.01
no schooling (n = 55,460)34.8[34.2,35.4]55.3[54.7,55.9]9.9[9.5,10.3]
less than 5 years (n = 11,701)19.4[18.4,20.5]62.5[61.1,63.9]18.1[16.9,19.3]
5–7 (n = 29,971)14.6[14.0,15.2]63.1[62.2,64.0]22.3[21.5,23.2]
8–9 (n = 34,576)12.7[12.1,13.2]62.3[61.4,63.2]25[24.2,25.9]
10–11 (n = 22,124)8.9[8.3,9.5]58.4[57.3,59.5]32.7[31.7,33.8]
12 or more years (n = 37,066)6.4[6.0,6.8]56.6[55.7,57.4]37[36.2,37.9]
Parityχ2 = 1002.6; p = <0.01
1 (n = 61,807)10.6[10.2,10.9]59.3[58.6,60.0]30.1[29.5,30.8]
2 to 3 (n = 95,548)16.7[16.3,17.1]59.6[59.1,60.2]23.7[23.2,24.2]
4 to 5 (n = 24,879)33.1[32.3,34.0]57.1[56.2,58.0]9.7[9.1,10.3]
6 or more (n = 8,664)47.3[45.9,48.8]48.5[47.0,49.9]4.2[3.6,4.9]
Economic Statusχ2 = 1131.5; p = <0.01
Poorest (n = 46,782)37.7[37.0,38.5]54.4[53.6,55.1]7.9[7.5,8.3]
Poorer (n = 43,739)19.5[18.9,20.1]63.2[62.5,64.0]17.3[16.7,17.9]
Middle (n = 38,393)11.9[11.4,12.4]61.9[61.1,62.7]26.2[25.4,27.0]
Richer (n = 33,212)8.2[7.7,8.7]59.8[58.8,60.8]32[31.0,33.0]
Richest (n = 28,772)5.1[4.6,5.7]54.5[53.4,55.6]40.4[39.3,41.5]
Religionχ2 = 48.7; p = <0.01
Hindu (n = 138,343)17.6[17.3,18.0]58.9[58.4,59.4]23.5[23.1,23.9]
Muslim (n = 29,309)20.3[19.4,21.3]58.8[57.7,59.9]20.9[19.9,21.9]
Others (n = 23,246)10.9[9.8,12.0]57.3[55.6,59.1]31.8[30.1,33.5]
Casteχ2 = 66.4; p = <0.01
Others (n = 34,705)12[11.4,12.6]58.9[57.9,59.8]29.1[28.2,30.1]
SC (n = 35,170)19.3[18.6,19.9]59.1[58.2,60.0]21.6[20.8,22.5]
ST (n = 37,889)21.6[20.7,22.6]59.4[58.3,60.5]19[18.1,19.9]
OBC (n = 74,060)19[18.5,19.4]58.1[57.5,58.6]23[22.5,23.5]
Place of residenceχ2 = 596.9; p = <0.01
Rural (n = 143,065)21.1[20.8,21.5]59.3[58.9,59.8]19.5[19.1,19.9]
Urban (n = 47,833)9.6[9.0,10.2]57.5[56.5,58.5]32.9[31.9,33.9]
Regionχ2 = 500.2; p = <0.01
South (n = 19,907)5.8[5.2,6.5]52.2[51.0,53.4]42[40.8,43.2]
North (n = 36,079)13.1[12.4,13.8]61.6[60.8,62.5]25.3[24.5,26.1]
Central (n = 52,952)23.4[22.8,24.0]65.3[64.7,65.9]11.3[10.9,11.8]
East (n = 39,243)27.7[26.9,28.4]56.8[56.0,57.7]15.5[14.8,16.2]
Northeast (n = 28,825)14[13.0,15.0]63.6[62.4,64.7]22.5[21.4,23.6]
West (n = 13,892)10[9.2,10.9]55[53.3,56.8]35[33.3,36.7]
High focus states of Indiaχ2 = 2579.0; p = <0.01
Non-High focus states (n = 78,380)8.5[8.0,8.9]55.3[54.5,56.1]36.2[35.4,37.0]
High focus states (n = 112,518)26[25.6,26.4]61.9[61.5,62.4]12.1[11.8,12.4]
At least 4 ANC visitsχ2 = 139.4; p = 0.000
Less than 4 (n = 101,460)36.3[35.7,36.9]63.7[63.1,64.3]0
Four or more (n = 89,438)054.1[53.5,54.8]45.9[45.2,46.5]
Intake of IFA 100+χ2 = 4016.9; p = <0.01
No (n = 138,082)22.9[22.5,23.3]64.2[63.7,64.6]13[12.6,13.3]
Yes (n = 52,816)5.9[5.5,6.3]46.4[45.7,47.2]47.7[46.9,48.5]
Place of deliveryχ2 = 381.1; p = <0.01
Respondent’s home (n = 37,758)41.8[40.9,42.7]51.5[50.7,52.4]6.7[6.2,7.2]
Other’s home (n = 381)35.1[28.0,43.0]52.2[44.5,59.8]12.7[8.5,18.6]
Parents’ home (n = 4,013)35[32.8,37.2]53.6[51.4,55.9]11.4[9.9,13.2]
Public: govt./munic. hospital (n = 47,772)11.1[10.6,11.6]60.1[59.2,61.0]28.8[28.0,29.6]
Public: govt. dispensary (n = 3,152)14.8[13.0,16.8]62.6[60.0,65.2]22.5[20.3,24.9]
Public: UHC/UHP/UFWC(n = 2,919)17.6[15.6,19.9]54.4[51.8,57.0]27.9[25.5,30.6]
Public: CHC/rural hospital/block PHC (n = 35,265)18.8[18.2,19.5]65.3[64.5,66.0]15.9[15.3,16.5]
Public: phc/additional PHC(n = 13,896)16.5[15.5,17.5]62.2[60.9,63.6]21.3[20.2,22.4]
Public: sub-centre (n = 2,373)15.7[13.7,17.9]65.2[62.1,68.1]19.2[16.5,22.1]
Other public sector health facility (n = 238)6.6[3.8,11.1]63.3[54.2,71.5]30.1[22.5,39.0]
Private: hospital/maternity home/clinic (n = 40,701)7.9[7.5,8.4]57.4[56.7,58.2]34.7[33.9,35.5]
Other private sector health facility (n = 942)14.4[11.6,17.7]64.7[60.3,68.8]20.9[17.5,24.8]
NGO or Trust hospital/clinic (n = 927)6.6[4.7,9.2]52.7[47.4,58.0]40.7[35.2,46.3]
other (n = 460)22.5[17.7,28.2]58.4[51.9,64.6]19.1[14.1,25.2]
Skilled PNC on day 1χ2 = 1262.8; p = <0.01
No skilled PNC on day 1 (n = 150,400)21.2[20.8,21.6]58.6[58.1,59.1]20.2[19.8,20.6]
Skilled PNC on day 1 (n = 40,498)6[5.7,6.4]59.4[58.6,60.3]34.5[33.7,35.4]
Table 3

Socioeconomic differentials observed among women with regards to quality delivery care accessed as captured by NFHS-4 (2015 16).

BACKGROUND VARIABLESNO QUALITY DELIVERY CAREQUALITY DELIVERY CARE
%95% CI%95% CI
Mother’s age at child birthχ2 = 240.3; p = <0.01
less than 19 (n = 13,849)18.3[17.4,19.3]81.7[80.7,82.6]
20–24 (n = 75,353)18.5[18.0,18.9]81.5[81.1,82.0]
25–29 (n = 62,536)20.6[20.1,21.1]79.4[78.9,79.9]
30–34 (n = 26,772)24.2[23.4,25.0]75.8[75.0,76.6]
35–39 (n = 9,412)33.5[32.1,34.9]66.5[65.1,67.9]
40–49 (n = 2,976)48.5[45.9,51.0]51.5[49.0,54.1]
Women’s educationχ2 = 1663.1 ; p = <0.01
no schooling (n = 55,460)38.5[37.9,39.2]61.5[60.8,62.1]
less than 5 years (n = 11,701)29.9[28.5,31.3]70.1[68.7,71.5]
5–7 (n = 29,971)20.7[19.9,21.4]79.3[78.6,80.1]
8–9 (n = 34,576)15.3[14.7,15.8]84.7[84.2,85.3]
10–11 (n = 22,124)9.7[9.2,10.3]90.3[89.7,90.8]
12 or more years (n = 37,066)6.2[5.9,6.6]93.8[93.4,94.1]
Parityχ2 = 2233.3 ; p = <0.01
1 (n = 61,807)10.9[10.5,11.3]89.1[88.7,89.5]
2 to 3 (n = 95,548)20.9[20.5,21.3]79.1[78.7,79.5]
4 to 5 (n = 24,879)39.1[38.2,40.0]60.9[60.0,61.8]
6 or more (n = 8,664)51.8[50.3,53.3]48.2[46.7,49.7]
Economic Statusχ2 = 1904.6 ; p = <0.01
Poorest (n = 46,782)41[40.2,41.7]59[58.3,59.8]
Poorer (n = 43,739)25.3[24.6,26.0]74.7[74.0,75.4]
Middle (n = 38,393)15.4[14.9,16.0]84.6[84.0,85.1]
Richer (n = 33,212)10.1[9.5,10.7]89.9[89.3,90.5]
Richest (n = 28,772)5.5[5.1,6.0]94.5[94.0,94.9]
Religionχ2 = 202.2; p = <0.01
Hindu (n = 138,343)19.2[18.8,19.5]80.8[80.5,81.2]
Muslim (n = 29,309)29.7[28.5,31.0]70.3[69.0,71.5]
Others (n = 23,246)18.1[16.6,19.6]81.9[80.4,83.4]
Casteχ2 = 140.5; p = <0.01
Others (n = 34,705)15.8[15.0,16.6]84.2[83.4,85.0]
SC (n = 35,170)21.7[21.0,22.4]78.3[77.6,79.0]
ST (n = 37,889)32.2[31.1,33.4]67.8[66.6,68.9]
OBC (n = 74,060)19.9[19.4,20.4]80.1[79.6,80.6]
Place of residenceχ2 = 833.1; p = <0.01
Rural (n = 143,065)24.8[24.4,25.2]75.2[74.8,75.6]
Urban (n = 47,833)11.5[10.9,12.1]88.5[87.9,89.1]
Regionχ2 = 592.6; p = <0.01
South (n = 19,907)6.1[5.5,6.6]93.9[93.4,94.5]
North (n = 36,079)15.7[15.1,16.4]84.3[83.6,84.9]
Central (n = 52,952)29.1[28.5,29.7]70.9[70.3,71.5]
East (n = 39,243)29.3[28.4,30.2]70.7[69.8,71.6]
Northeast (n = 28,825)29.1[27.8,30.5]70.9[69.5,72.2]
West (n = 13,892)12[11.1,13.0]88[87.0,88.9]
High focus states of Indiaχ2 = 1442.0; p = <0.01
Non-High focus states (n = 78,380)12.4[11.8,12.9]87.6[87.1,88.2]
High focus states (n = 112,518)28.4[28.0,28.9]71.6[71.1,72.0]
At least 4 ANC visitsχ2 = 4033.1 ; p = <0.01
Less than 4 (n = 101,460)31.9[31.3,32.4]68.1[67.6,68.7]
Four or more (n = 89,438)10.3[10.0,10.7]89.7[89.3,90.0]
Intake of IFA 100+χ2 = 2279.1 ; p = <0.01
No (n = 138,082)25.6[25.2,26.1]74.4[73.9,74.8]
Yes (n = 52,816)9.7[9.3,10.2]90.3[89.8,90.7]
Place of deliveryχ2 = 5641.4; p = <0.01
Respondent’s home (n = 37,758)1000
Other’s home (n = 381)1000
Parents’ home (n = 4,013)1000
Public: govt./munic. hospital (n = 47,772)1.9[1.8,2.1]98.1[97.9,98.2]
Public: govt. dispensary (n = 3,152)3.9[3.0,5.1]96.1[94.9,97.0]
Public: UHC/UHP/UFWC(n = 2,919)3[2.3,3.8]97[96.2,97.7]
Public: CHC/rural hospital/block PHC (n = 35,265)2.7[2.5,3.0]97.3[97.0,97.5]
Public: phc/additional PHC(n = 13,896)2.6[2.2,3.0]97.4[97.0,97.8]
Public: sub-centre (n = 2,373)3.5[2.5,5.0]96.5[95.0,97.5]
Other public sector health facility (n = 238)2.3[0.9,5.3]97.7[94.7,99.1]
Private: hospital/maternity home/clinic (n = 40,701)2.3[2.1,2.6]97.7[97.4,97.9]
Other private sector health facility (n = 942)4.2[2.9,6.1]95.8[93.9,97.1]
NGO or Trust hospital/clinic (n = 927)4.3[2.7,6.7]95.7[93.3,97.3]
other (n = 460)1000
Skilled PNC on day 1χ2 = 2771.4; p = <0.01
No skilled PNC on day 1 (n = 150,400)24.9[24.5,25.4]75.1[74.6,75.5]
Skilled PNC on day 1 (n = 40,498)7.2[6.8,7.5]92.8[92.5,93.2]
Table 4

Socioeconomic differentials observed among women with regards to quality PNC accessed as captured by NFHS-4 (2015–16).

BACKGROUND CHARACTERISTICSNO SKILLED PNC BY DAY 1SKILLED PNC BY DAY 1
ROW %95% CIROW %95% CI
Mother’s age at child birthχ2 = 10.8; p = <0.01
less than 19 (n = 13,849)76.8[75.7,78.0]23.2[22.0,24.3]
20–24 (n = 75,353)76.4[75.9,77.0]23.6[23.0,24.1]
25–29 (n = 62,536)76.7[76.2,77.3]23.3[22.7,23.8]
30–34 (n = 26,772)77.8[76.9,78.6]22.2[21.4,23.1]
35–39 (n = 9,412)79.8[78.2,81.3]20.2[18.7,21.8]
40–49 (n = 2,976)84.4[82.5,86.2]15.6[13.8,17.5]
Women’s educationχ2 = 161.8; p = <0.01
no schooling (n = 55,460)83.4[82.9,83.9]16.6[16.1,17.1]
less than 5 years (n = 11,701)78.3[77.1,79.5]21.7[20.5,22.9]
5–7 (n = 29,971)77.1[76.3,77.9]22.9[22.1,23.7]
8–9 (n = 34,576)75.1[74.3,75.9]24.9[24.1,25.7]
10–11 (n = 22,124)72.9[71.8,73.9]27.1[26.1,28.2]
12 or more years (n = 37,066)71.9[71.1,72.7]28.1[27.3,28.9]
Parityχ2 = 152.0; p = <0.01
1 (n = 61,807)74.4[73.8,75.0]25.6[25.0,26.2]
2 to 3 (n = 95,548)76.8[76.2,77.3]23.2[22.7,23.8]
4 to 5 (n = 24,879)82.6[81.9,83.3]17.4[16.7,18.1]
6 or more (n = 8,664)85.3[84.2,86.3]14.7[13.7,15.8]
Economic statusχ2 = 261.7; p = <0.01
Poorest (n = 46,782)84.8[84.3,85.3]15.2[14.7,15.7]
Poorer (n = 43,739)79.1[78.4,79.7]20.9[20.3,21.6]
Middle (n = 38,393)75.4[74.6,76.1]24.6[23.9,25.4]
Richer (n = 33,212)72.2[71.3,73.2]27.8[26.8,28.7]
Richest (n = 28,772)70.5[69.5,71.5]29.5[28.5,30.5]
Religionχ2 = 29.3; p = 0.000
Hindu (n = 138,343)76.9[76.5,77.3]23.1[22.7,23.5]
Muslim (n = 29,309)78.8[77.8,79.8]21.2[20.2,22.2]
Others (n = 23,246)71.6[70.1,73.1]28.4[26.9,29.9]
Casteχ2 = 10.6; p = <0.01
Others (n = 34,705)75.6[74.7,76.5]24.4[23.5,25.3]
SC (n = 35,170)76.5[75.7,77.3]23.5[22.7,24.3]
ST (n = 37,889)79.4[78.4,80.4]20.6[19.6,21.6]
OBC (n = 74,060)76.9[76.4,77.4]23.1[22.6,23.6]
Place of residenceχ2 = 76.8; p = <0.01
Rural (n = 143,065)78.2[77.8,78.6]21.8[21.4,22.2]
Urban (n = 47,833)73.9[73.0,74.8]26.1[25.2,27.0]
Regionχ2 = 72.6; p = <0.01
South (n = 19,907)70.7[69.6,71.8]29.3[28.2,30.4]
North (n = 36,079)75.5[74.6,76.3]24.5[23.7,25.4]
Central (n = 52,952)77.4[76.8,78.0]22.6[22.0,23.2]
East (n = 39,243)81.6[80.9,82.3]18.4[17.7,19.1]
Northeast (n = 28,825)81.9[80.8,82.9]18.1[17.1,19.2]
West (n = 13,892)76.1[74.5,77.6]23.9[22.4,25.5]
High focus states of Indiaχ2 = 257.5; p = <0.01
Non-High focus states (n = 78,380)73.6[72.9,74.3]26.4[25.7,27.1]
High focus states (n = 112,518)80[79.6,80.4]20[19.6,20.4]
At least 4 ANC Visitsχ2 = 1269.6; p = <0.01
Less than 4 (n = 101,460)83.8[83.3,84.2]16.2[15.8,16.7]
Four or more (n = 89,438)70.5[69.9,71.1]29.5[28.9,30.1]
Intake of IFA 100+χ2 = 384.1; p = <0.01
No (n = 138,082)79.3[78.9,79.7]20.7[20.3,21.1]
Yes (n = 52,816)71.6[70.9,72.4]28.4[27.6,29.1]
Place of deliveryχ2 = 197.0; p = <0.01
Respondent’s home (n = 37,758)93.1[92.7,93.5]6.9[6.5,7.3]
Other’s home (n = 381)88.9[84.6,92.2]11.1[7.8,15.4]
Parents’ home (n = 4,013)91.2[89.8,92.4]8.8[7.6,10.2]
Public: govt./munic. hospital (n = 47,772)72.8[71.9,73.6]27.2[26.4,28.1]
Public: govt. dispensary (n = 3,152)75.7[73.1,78.1]24.3[21.9,26.9]
Public: UHC/UHP/UFWC (n = 2,919)75.3[72.9,77.6]24.7[22.4,27.1]
Public: CHC/Rural hospital/block PHC (n = 35,265)75.3[74.5,76.0]24.7[24.0,25.5]
Public: PHC/additional PHC (n = 13,896)75.5[74.2,76.7]24.5[23.3,25.8]
Public: Sub-centre (n = 2,373)74.5[71.7,77.1]25.5[22.9,28.3]
Other public sector health facility (n = 238)75.3[67.2,81.9]24.7[18.1,32.8]
Private: hospital/maternity home/clinic (n = 40,701)71.6[70.8,72.4]28.4[27.6,29.2]
Other private sector health facility (n = 942)76.6[72.2,80.4]23.4[19.6,27.8]
NGO or trust hospital/clinic (n = 927)75.4[70.3,79.8]24.6[20.2,29.7]
Other (n = 460)84.3[79.7,88.1]15.7[11.9,20.3]
Table 5

Parameter estimates of random effect variances and Intra-class correlation of binary regression conducted for determinants of services along the continuum of care at district and PSU levels, India (2015–16).

PARAMETER ESTIMATESQUALITY OF ANTENATAL CAREQUALITY OF DELIVERY CAREQUALITY OF POSTNATAL CARE FOR NEW BORN
MODEL 1 (EMPTY MODEL)MODEL 2 (FULL MODEL)MODEL 1 (EMPTY MODEL)MODEL 2 (FULL MODEL)MODEL 1 (EMPTY MODEL)MODEL 2 (FULL MODEL)
SEP-VALUE95%CISEP-VALUE95% CISEP-VALUE95% CISEP-VALUE95% CISEP-VALUE95% CISEP-VALUE95% CI
Random-effects Parameters
District level variance2.010.121.79–2.261.080.070.95–1.221.160.110.96–1.390.790.080.65–0.971.260.11.08–1.461.220.11.04–1.42
PSU level variance1.140.031.09–1.1910.020.96–1.051.340.121.13–1.601.060.110.86–0.302.660.112.45–2.902.660.112.45–2.90
Infraclass correlation coefficient (ICC)
District level0.310.010.29–0.340.20.010.18–0.220.20.010.17–0.230.150.010.13–0.180.170.010.15–0.200.170.010.15–0.19
PSU level0.490.010.47–0.510.390.010.37–0.400.430.020.40–0.470.360.020.32–0.400.540.010.52–0.560.540.010.52–0.56
Table 6

Binary regression analysis showing determinants of continuum of care, India (2015–16).

BACKGROUND VARIABLESQUALITY ANTENATAL CAREQUALITY DELIVERY CAREQUALITY POSTNATAL CARE
ORP-VALUE95% CIORP-VALUE95% CIORP-VALUE95% CI
Individual/household level
Age at birth
<=19 (ref.)
20–241.12<0.011.061.191.120.240.931.340.990.920.871.13
25–291.24<0.011.161.321.210.061.01.470.950.460.831.09
30–341.35<0.011.261.451.71<0.011.362.150.980.760.831.14
35–391.21<0.011.11.331.510.011.122.031.080.470.871.34
40–491.31<0.011.121.541.370.170.872.151.10.640.741.61
Women’s education
no schooling (ref.)
Less than 5 years1.16<0.011.081.2510.970.841.211.44<0.011.21.72
5 to 7 years1.30<0.011.231.371.140.090.981.311.20.011.051.37
8 to 9 years1.49<0.011.421.571.43<0.011.221.661.190.011.041.35
10 to 11 years1.64<0.011.551.741.56<0.011.311.871.10.170.961.26
12 or more years1.95<0.011.842.072.06<0.011.712.471.130.080.991.29
Parity
1 (ref.)
2 to 30.8<0.010.780.830.47<0.010.420.531.050.190.981.13
4 to50.56<0.010.520.590.3<0.010.250.3610.960.851.17
6 and above0.38<0.010.330.430.23<0.010.170.321.130.520.781.63
Gender composition of living children
No sons (ref.)
At least one son0.990.450.961.020.920.10.831.021.020.590.951.09
Wealth quintile
Poorest (ref.)
Poorer1.37<0.011.31.451.42<0.011.241.640.890.110.771.03
Middle1.67<0.011.581.781.79<0.011.512.110.900.190.781.05
Richer1.98<0.011.852.112.13<0.011.752.590.920.330.791.08
Richest2.55<0.012.372.752.86<0.012.273.610.920.330.771.09
Caste
Others (ref.)
Scheduled Castes0.9<0.010.860.950.980.810.841.150.980.780.881.1
Scheduled Tribes0.85<0.010.790.90.71<0.010.600.840.890.120.771.03
Other Backward Class0.93<0.010.890.970.980.830.861.130.990.760.91.08
Religion
Hindu (ref.)
Muslim0.970.260.911.020.61<0.010.520.710.980.780.871.11
Others0.940.110.881.010.920.370.761.110.960.590.841.11
Contextual level
Place of current residence
Rural (ref.)
Urban1.010.670.961.071.10.180.961.270.910.080.811.01
High focus states
No (ref.)
Yes0.3500.30.410.840.080.691.021.4101.151.74
Proportion of illiterate in PSU
0–25% (ref.)
25–50%0.970.320.921.030.820.010.720.950.970.580.871.08
50–75%0.89<0.010.840.950.71<0.010.610.840.960.570.841.1
75–100%0.73<0.010.670.80.740.010.610.920.820.060.671.01
Proportion of poor in PSU
0–25% (ref.)
25–50%0.970.370.911.040.74<0.010.630.871.070.350.931.22
50–75%0.920.030.860.990.74<0.010.620.891.070.430.911.25
75–100%0.79<0.010.730.860.51<0.010.410.631.010.920.831.22

[i] Note: OR: Odds Ratio; PSU: Primary Sampling Unit.

DOI: https://doi.org/10.5334/aogh.3586 | Journal eISSN: 2214-9996
Journal RSS Feed
Language: English
Submitted on: Sep 20, 2021
Accepted on: May 6, 2022
Published on: May 26, 2022
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
maternal and child health,
quality of care,
continuum of care,
health equity,
India

© 2022 Lucky Singh, Ritam Dubey, Prashant Kumar Singh, Saritha Nair, Rajesh Kumar Rai, M. Vishnu Vardhana Rao, Shalini Singh, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 88 (2022): Issue 1
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