PMID- 34011316
OWN - NLM
STAT- MEDLINE
DCOM- 20211105
LR  - 20240402
IS  - 1471-2393 (Electronic)
IS  - 1471-2393 (Linking)
VI  - 21
IP  - 1
DP  - 2021 May 19
TI  - Pro-poor policies and improvements in maternal health outcomes in India.
PG  - 389
LID - 10.1186/s12884-021-03839-w [doi]
LID - 389
AB  - BACKGROUND: Since 2005, India has experienced an impressive 77% reduction in 
      maternal mortality compared to the global average of 43%. What explains this 
      impressive performance in terms of reduction in maternal mortality and 
      improvement in maternal health outcomes? This paper evaluates the effect of 
      household wealth status on maternal mortality in India, and also separates out 
      the performance of the Empowered Action Group (EAG) states and the Southern 
      states of India. The results are discussed in the light of various pro-poor 
      programmes and policies designed to reduce maternal mortality and the existing 
      supply side gaps in the healthcare system of India. Using multiple sources of 
      data, this study aims to understand the trends in maternal mortality (1997-2017) 
      between EAG and non EAG states in India and explore various household, economic 
      and policy factors that may explain reduction in maternal mortality and 
      improvement in maternal health outcomes in India. METHODS: This study 
      triangulates data from different rounds of Sample Registration Systems to assess 
      the trend in maternal mortality in India. It further analysed the National Family 
      Health Surveys (NFHS). NFHS-4, 2015-16 has gathered information on maternal 
      mortality and pregnancy-related deaths from 601,509 households. Using logistic 
      regression, we estimate the association of various socio-economic variables on 
      maternal deaths in the various states of India. RESULTS: On an average, wealth 
      status of the households did not have a statistically significant association 
      with maternal mortality in India. However, our disaggregate analysis reveals, the 
      gains in terms of maternal mortality have been unevenly distributed. Although the 
      rich-poor gap in maternal mortality has reduced in EAG states such as Bihar, 
      Odisha, Assam, Rajasthan, the maternal mortality has remained above the national 
      average for many of these states. The EAG states also experience supply side 
      shortfalls in terms of availability of PHC and PHC doctors; and availability of 
      specialist doctors. CONCLUSIONS: The novel contribution of the present paper is 
      that the association of household wealth status and place of residence with 
      maternal mortality is statistically not significant implying financial barriers 
      to access maternal health services have been minimised. This result, and India's 
      impressive performance with respect to maternal health outcomes, can be 
      attributed to the various pro-poor policies and cash incentive schemes 
      successfully launched in recent years. Community-level involvement with pivotal 
      role played by community health workers has been one of the major reasons for the 
      success of many ongoing policies. Policy makers need to prioritise the 
      underperforming states and socio-economic groups within the states by addressing 
      both demand-side and supply-side measures simultaneously mediated by contextual 
      factors.
FAU - Bhatia, M
AU  - Bhatia M
AUID- ORCID: 0000-0001-9366-142X
AD  - Department of Health Policy, London School of Economics and Political Science, 
      Houghton Street, London, WC2A 2AE, UK. m.r.bhatia@lse.ac.uk.
FAU - Dwivedi, L K
AU  - Dwivedi LK
AD  - International Institute for Population Sciences, Mumbai, India.
FAU - Banerjee, K
AU  - Banerjee K
AD  - International Institute for Population Sciences, Mumbai, India.
FAU - Bansal, A
AU  - Bansal A
AD  - International Institute for Population Sciences, Mumbai, India.
FAU - Ranjan, M
AU  - Ranjan M
AD  - Department of Statistics, Mizoram University, Pachhunga University College 
      Campus, Aizawl, Mizoram, India.
FAU - Dixit, P
AU  - Dixit P
AD  - School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, 
      India.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20210519
PL  - England
TA  - BMC Pregnancy Childbirth
JT  - BMC pregnancy and childbirth
JID - 100967799
SB  - IM
MH  - Adult
MH  - Female
MH  - *Health Status Disparities
MH  - Health Surveys
MH  - Humans
MH  - Income/*statistics & numerical data
MH  - India/epidemiology
MH  - *Maternal Mortality/trends
MH  - Poverty/*statistics & numerical data
MH  - Socioeconomic Factors
MH  - Young Adult
PMC - PMC8135986
OTO - NOTNLM
OT  - Conditional cash transfers
OT  - Demand side financing
OT  - Developing countries
OT  - Financial incentives
OT  - India
OT  - Maternal health
OT  - Maternal health outcomes
OT  - Maternal mortality
COIS- None.
EDAT- 2021/05/21 06:00
MHDA- 2021/11/06 06:00
PMCR- 2021/05/19
CRDT- 2021/05/20 05:37
PHST- 2020/08/21 00:00 [received]
PHST- 2021/04/28 00:00 [accepted]
PHST- 2021/05/20 05:37 [entrez]
PHST- 2021/05/21 06:00 [pubmed]
PHST- 2021/11/06 06:00 [medline]
PHST- 2021/05/19 00:00 [pmc-release]
AID - 10.1186/s12884-021-03839-w [pii]
AID - 3839 [pii]
AID - 10.1186/s12884-021-03839-w [doi]
PST - epublish
SO  - BMC Pregnancy Childbirth. 2021 May 19;21(1):389. doi: 10.1186/s12884-021-03839-w.