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Abha Gupta, Pushpendra Kumar and Olalemi Adewumi Dorcas

and most of them could have been prevented (WHO, 2015) with a proper and timely utilization of
ANC services and medically-assisted delivery (Adam, Lim, Mehta et al., 2005). Some studies have
examined the effectiveness of ANC in achieving improved maternal and child health.
They concluded that antenatal visits have multiple positive implications such as early detection of
pregnancy complications and anaemia, delivery at a medical institution, increased use of contr-
aceptive, and consequently a decline in infant and maternal mortality rate (Adam, Lim, Mehta et al.,
2005; Campbell and Graham, 2006; Choi and Lee, 2006; Hollowell, Oakle, Kurinczuk et al., 2011;
Mishra and Retherford, 2006; Navaneetham and Dharmalingam, 2002; Wehby, Murray, Castilla et al.,
2009).
India continues to have a high maternal mortality rate despite its strong economic growth and ad-
vancement in science, technology, and medicine (Pathak, Singh, and Subramanian, 2010). It contrib-
utes to 20% of global maternal deaths (Mavalankar, Vora, and Prakasamma, 2008). These esti-
mates clearly show that India is likely to continue to play a significant role in achieving global de-
velopment goals, in particular, the United Nations Sustainable Development Goals (United Nations,
2015). However, vast socio-economic inequalities, poor health services, political unwillingness,
and cultural constraints have posed significant challenges to achieving low maternal mortality rate
(Navaneetham and Dharmalingam, 2002; Pallikadavath, Foss, and Stones, 2004a; Ram and Singh,
2006; Sunil, Rajaram, and Zottarelli, 2006). Also, the socio-economic disparities are more pervasive
in economically poor states of India such as Jharkhand (Singh and Chaturvedi, 2015), which has a
high maternal mortality ratio of 261 compared to the national average of 212 per 100,000 births in
2009 (Ogala, Avan, Roy et al., 2012). ANC services are not uniformly available and accessible to
most of the population in the state according to estimates from DLHS-3 (2007–2008), which shows
that the utilization of ANC services is significantly lower among scheduled castes, scheduled tribes,
Muslims, and the economically poor and in rural areas. Therefore, to ameliorate the maternal
health conditions in the state, in-depth research is needed to identify factors that affect maternal
health and to quantify their relative contributions so that the socially and economically vulnerable
persons could be targeted.
A number of studies previously have examined factors causing inequalities in maternal health
(Obiyan and Kumar, 2015; Singh, Kumar, Rai et al., 2014; Tsawe, Moto, Netshivhera et al., 2015).
However, to the best of our knowledge, none of the studies in the existing literature have decom-
posed the contribution of socio-economic factors in full ANC utilization in Jharkhand state.
Therefore, this paper attempts to fill this research gap and aims to examine the associations between
socio-economic factors and full ANC utilization as well as their relative contributions towards gen-
erating inequalities.

2. Materials and Methods

2.1 Data

This paper used the third wave of the District Level Household and Facility Survey (DLHS-3) da-
ta, conducted in India during 2007–2008. The survey covered 601 districts from 34 states and union
territories of India. In Jharkhand state (see Figure 1), DLHS-3 survey covered 26,886 ever-married
women (aged 15–49) using a multi-stage stratified sampling design. In the first stage, 50 primary
sampling units (PSUs), which are census villages in rural areas and wards in urban areas, were
selected from each district by using a systematic probability proportional to size (PPS) sampling
method. In the second stage, circular systematic sampling was used to select the required number of
households from the villages. Among the ever-married women, 11,373 women had their last
live/still birth and 1,035 of them used full ANC services.

International Journal of Population Studies | 2016, Volume 2, Issue 2 93