Page 107 - IJPS-2-2

Abha Gupta, Pushpendra Kumar and Olalemi Adewumi Dorcas

12% of SC and 26% of ST population reside in Jharkhand state, and more than 75% of their popula-
tion lives in rural areas (Office of the Registrar General and Census Commissioner, 2011). It is also
evident that nearly 46% of the rural population is living below the poverty line in the state
(Chaudhuri and Gupta, 2009). Jharkhand also performs poorly on maternal health in terms of high
maternal mortality rate, low utilization of antenatal and safe delivery services (International Institute
for Population Sciences, 2007–2008). Therefore, this paper is an attempt in this direction to identify
the socio-economic factors and to quantify their contributions in generating inequalities in utilization
of full ANC services among women in Jharkhand state, which makes a solid contribution to the ex-
isting literature on maternal health disparity determination in India. The results would help identify
vulnerable populations and bridge the socio-economic gaps. However, it is worth noting that this
paper is based on DLHS-3 data which was conducted in 2007–2008. Recent estimates on ANC ser-
vices show improved conditions in Jharkhand where 14% of women are using full ANC in
2011–2012 as against 9% in 2007–2008 (Office of the Registrar General and Census Commissioner,
2011–2012). Therefore, much care is needed while drawing inferences.
Results from this paper suggest that factors such as parity of women, their educational level, age
at first birth, economic status, and exposure to mass media were significantly associated with the
utilization of full ANC services. These findings are consistent with other contemporary studies
which have identified socio-economic and regional factors related to maternal health (Hajizadeh,
Alam, Nandi et al., 2014; Pandey, Roy, Sahu et al., 2004). Several studies show that women with
fewer number of children prefer to use ANC services as they place their first child at high value even
in times of economic crisis (Pell, Menaca, Were et al., 2013; Singh and Singh, 2014), whereas high
parity mothers receive experience from their past births and show lower concern in ANC utilization
(Arthur, 2012). Sometimes, women attend one visit of ANC centers to obtain a health card so that
they can deliver their child in a medical institution without the intent to receive further care during
pregnancy (Pell, Menaca, Were et al., 2013). There are also a number of regional studies showing
that education and other factors such as income and higher age at marriage are positively linked with
the utilization of ANC services (Gupta, Chhabra, Kannan et al., 2010; Navaneetham and
Dharmalingam, 2002; Pallikadavath, Foss, and Stones, 2004b). A comparative study of three major
states of India demonstrated that the wealthy women living in urban areas with post primary educa-
tion, low parity and any exposure to mass media were more likely to receive prenatal care than
their counterpart groups (Pathak, Singh, and Subramanian, 2010).
Socio-economic disparities in utilization of ANC services can lead to wretched maternal
health conditions among vulnerable groups; a study from Bangladesh showed that lower utilization
of ANC services along with other components of maternal health among poor, uneducated and rural
women posed a major impediment to achieving overall maternal and child health (Hajizadeh, Alam,
Nandi et al., 2014). Similar arguments were also raised by scholars who identified that women
among lower income strata (Pandey, Roy, Sahu et al., 2004), Muslim, Scheduled Tribe, illiterate, and
higher age groups were less likely to access ANC services. Poor knowledge, attitude and practices
for ANC check-ups may be the main reasons for deplorable conditions of those women (Manna, De,
and Ghosh, 2011).
The findings from this paper not only identify the factors affecting the utilization of full ANC but
also their quantitative contributions towards inequalities. From our results, the economic status of
women emerged as the major contributor of inequalities in ANC access. Furthermore, exposure to
any form of mass media contributed around 31% to total inequality in ANC utilization. These results
reflect that women who are aware of the importance of ANC choose to utilize those services. Thus,
awareness of the health program among women through any source of media makes a difference in
the utilization of ANC services. A study found that educational status of women and exposures to
mass media were important issues to address to improving maternal health conditions (Kulkarni and
Nimbalkar, 2008). Another study which was conducted in urban India demonstrated that mothers’
education, economic well-being and exposure to mass media were significant factors contributing

International Journal of Population Studies | 2016, Volume 2, Issue 2 101