Page 103 - GHES-3-1

Global Health Economics and
Sustainability
Maternal health-care service utilization

whereas for the richest, access increased from 61.65% in improvement and are in a favorable state as of 2021. For
1998 to 75.47% in 2021. the poorest women, SBA increased by 64.95% in rural areas
(from 12.58% in 1998 to 77.5% in 2021) and 44.83% in
3.2. MHCS utilization between poorest and richest urban areas (from 34.76% in 1998 to 79.59% in 2021). PNC
women in India by sector has most significantly improved for the poorest women in
Regional imbalances play a crucial role in MHCS utilization. both rural and urban areas.
The rural population faces more hurdles in accessing
MHCSs than the urban population. Findings from Table 2 3.3. MHCS utilization between poorest and richest
suggest that ANC4+ coverage in rural areas increased by women in the EAG states of India
31.29% from 1998 to 2021 (from 10.31% in 1998 to 41.6% Table 3 indicates that the utilization of ANC4+ among
in 2021), whereas the increase in urban areas was 26.05% women in India increased by an average of 31% from 1998
(from 19.72% in 1998 to 45.77% in 2021), indicating a to 2021, largely due to significant improvements among
relatively larger improvement in rural areas. There has been the poorest mothers. ANC4+ utilization was highest in
an improvement in ANC4+ for the richest women in both Bihar for both the poorest (66.67%) and richest (87.77%)
rural and urban areas, with a bi-directional trend. In rural mothers. Conversely, it was lowest in Madhya Pradesh,
areas, for the richest women, ANC4+ improved by 12.46% with 24.44% for the poorest and 61.95% for the richest
(from 54.71% in 1998 to 67.17% in 2021), whereas in urban women in 2021, showing significant fluctuations before
areas, ANC4+ declined by 2.52% during the same period. 2021. SBA utilization varied: for the poorest women and
For SBA, the findings suggest that the richest women, in was highest in Uttar Pradesh in 2021 at 84.75% and lowest
both rural and urban areas, have shown a greater percentage in Bihar at 33.33%. For the richest women, Bihar achieved
100 percent SBA utilization, with almost all the EAG states
Table 1. MHCS utilization between the poorest and richest performing well. PNC utilization was highest in Bihar for
women in India the poorest mothers at 100%. In Odisha, PNC utilization

Year ANC4+ SBA PNC peaked in 2015 but declined to 73.11%. For the richest
Poorest Richest Poorest Richest Poorest Richest mothers, the highest PNC utilization was in Rajasthan at
1998 10.8 67.26 13.74 71.7 0.00 61.65 77.09%, whereas the lowest was 66.89% in Uttar Pradesh.
2005 12.15 77.36 13.2 85.57 32.66 45.85 3.4. Determinants of MHCS utilization among the
2015 32.66 45.85 61.48 96.25 53.27 83.07 EAG states of India
2021 41.8 71.82 77.6 96.83 82.13 75.47 The results of the determinants of MHCS utilization are
Source: Authors’ estimation based on NFHS data from different rounds. presented in Table 4, which shows that ANC4+ and SBA
Abbreviations: ANC4+: Antenatal care; PNC: Postnatal care; were statistically significant in 2005 – 2006. However,
SBA: Skilled birth assistance; MHCS: Maternal health-care service.
there were no significant differences in the utilization of
Table 2. MHCS between poorest and richest women in India ANC4+, SBA, and PNC in 2015 – 2016 and 2019 – 2021.
by sector Women over 25 years of age were less likely to use MHCS
than women aged 15 – 24 years. Women’s education has a
Year ANC4+ SBA PNC strong impact on MHCS utilization in EAG states. Women
Poorest Richest Poorest Richest Poorest Richest with primary, secondary, and higher levels of education
Rural were more likely to utilize MHCSs than women with no
1998 10.31 54.71 12.58 56.77 0.00 42.64 education. Women belonging to the Muslim and other
2005 11.62 69.68 12.58 78.5 32.26 46.5 communities were less likely to use MHCS than their Hindu
2015 24.44 68.4 61.37 95.57 53.15 84.74 counterparts. Poorer, middle, richer, and richest women
were less likely to use MHCSs than the poorest women.
2021 41.6 67.17 77.5 96.69 82.24 78.6
High degrees of MME and autonomy among women were
Urban positively associated with higher utilization of MHCSs.
1998 19.72 76.52 34.76 82.7 0.00 73.2 There are mixed results regarding regional differences in
2005 23.25 80.39 25.9 88.37 38.66 45.62 MHCS utilization. Regional differences also play a crucial
2015 35.79 74.97 63.59 96.53 55.54 82.39 role in MHCS utilization. Results show that women from
2021 45.77 74 79.59 96.89 79.35 73.83 Uttarakhand, Rajasthan, Uttar Pradesh, Bihar, Jharkhand,
Odisha, and Madhya Pradesh were less likely to visit health
Source: Authors’ estimation based on NFHS data from different rounds.
Abbreviations: ANC4+: Antenatal care; PNC: Postnatal care; centers for ANC compared to women from Chhattisgarh
SBA: Skilled birth assistance; MHCS: Maternal health-care service. in all periods.

Volume 3 Issue 1 (2025) 95 https://doi.org/10.36922/ghes.3324