Has India's National Rural Health Mission Reduced Inequities in Maternal Health Services? A Pre-Post Repeated Cross-Sectional Study

Health Policy and Planning, czw100

12 Pages Posted: 11 Nov 2016

See all articles by Sukumar Vellakkal

Sukumar Vellakkal

Public Health foundation of India (PHFI)

Adyya Gupta

University of Adelaide - School of Public Health

Zaky Khan

Public Health Foundation of India

David Stuckler

Oxford University

Aaron Reeves

University of Oxford

Shah Ebrahim

Public Health Foundation of India

Ann Bowling

University of Southampton

Pat Doyle

LSHTM

Date Written: August 10, 2016

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.

Keywords: India, maternal healthcare, National Rural Health Mission, impact valuation, public health program, socioeconomic inequity

JEL Classification: G38, H41, I13, I14, I18

Suggested Citation

Vellakkal, Sukumar and Gupta, Adyya and Khan, Zaky and Stuckler, David and Reeves, Aaron and Ebrahim, Shah and Bowling, Ann and Doyle, Pat, Has India's National Rural Health Mission Reduced Inequities in Maternal Health Services? A Pre-Post Repeated Cross-Sectional Study (August 10, 2016). Health Policy and Planning, czw100. Available at SSRN: https://ssrn.com/abstract=2867839

Sukumar Vellakkal (Contact Author)

Public Health foundation of India (PHFI) ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

HOME PAGE: http://www.phfi.org

Adyya Gupta

University of Adelaide - School of Public Health ( email )

Room No. 7.31, Level 7/178 North Terrace
Adelaide, 5005
Australia

Zaky Khan

Public Health Foundation of India ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

David Stuckler

Oxford University ( email )

Mansfield Road
Oxford, Oxfordshire OX1 4AU
United Kingdom

Aaron Reeves

University of Oxford ( email )

Mansfield Road
Oxford, Oxfordshire OX1 4AU
United Kingdom

Shah Ebrahim

Public Health Foundation of India ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

Ann Bowling

University of Southampton ( email )

University Rd.
Southampton SO17 1BJ, Hampshire SO17 1LP
United Kingdom

Pat Doyle

LSHTM ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

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