A STUDY ON MATERNAL HEALTH CARE IN INDIA

Abstract

South Asia is grappling with a triple burden of high maternal mortality and child malnutrition, coupled with the high prevalence of patriarchal social structure. However, maternal healthcare service utilization can significantly reduce maternal mortality and morbidity, improve child health, and is indispensable for achieving several United Nations Sustainable Development Goals. The study analysed the socio-economic and demographic factors affecting maternal healthcare use in the South Asian countries. This analysis used a modified framework of Anderson’s behavioural model of health service use and included Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. Furthermore, the concomitant factors influencing breastfeeding practices in India were examined. The study then analysed the impact of maternal healthcare service utilization on under-five child health outcomes in India. To examine under-five child health outcomes in India, the study applied the Fundamental Cause Theory. This theory, derived from Geoffrey Rose's "Cause of Causes," was used to analyze the impact of water and sanitation, maternal healthcare service utilization, and breastfeeding practices. For this purpose, the two latest rounds of the Indian Demographic Health Survey [DHS (2015-16) and DHS (2019-21)] were employed. The study then adopted Connell’s gender and power theory. This framework was used to discuss how women's autonomy in managing their healthcare impacts abortion history, knowledge of contraceptive methods, wanted pregnancy, and delivery via caesarean section in India. For this analysis, the study used data from the last two rounds of the Indian Demographic Health Survey. Lastly, the study examined the impact of coercive control experienced by women on child health outcomes in South Asia. The impact of coercive control experienced by women on child health outcomes was elucidated using the family disruption model. The study used data extracted from the nationally representative Demographic and Health Survey. For the analysis, descriptive statistics, generalized ordered logit model, multivariable logistic regression, negative binomial model, time interaction regression model and a mixed- effect logistic model were employed in the study. The study found that the women who were educated, working, had decision- making autonomy, and were aware of family planning were more likely to avail of maternal healthcare services in South Asia. Furthermore, our study highlighted the disparities in maternal healthcare service utilization and associated factors among the selected South Asian nations. For instance, working mothers had lower odds of receiving antenatal care in Afghanistan and delivery care in Bangladesh. In addition, women with higher educational attainment, access to mass media, resided in rural areas, received maternal healthcare services, and received assistance from Anganwadi were more likely to have optimum breastfeeding practices. Remarkably, employed mothers had higher odds of longer durations of breastfeeding, but they had lower odds of exclusive breastfeeding. We observed that in 2015-16, unimproved sanitation facilities and open defecation increased the odds of poor child health outcomes. In 2019-21, mothers who had not received at least four antenatal care visits v were more likely to have stunted and underweight children. However, the strength of this association between antenatal care visits and child health outcomes diminished between the two survey rounds. However, it is worth noting that in both 2015-16 and 2019-21 the absence of exclusive breastfeeding decreased the odds of under-five wasting. Furthermore, the decline in the prevalence of underweight was likely to be less for children who used unimproved sanitation facilities and practised open defecation and whose mothers have not received postnatal care visits. In 2015-16 and 2019-21, the odds of wanted pregnancy were higher among women who managed their healthcare decisions jointly with their partner. Also, the odds of knowing contraceptive methods were lower among women whose healthcare decisions were made solely by the husband/partner in 2015-16. Furthermore, it was observed that a mother who has experienced physical violence during pregnancy was more likely to have a stunted and underweight child. Women who reported emotional violence, sexual violence, physical violence, interview interruption by an adult and high spousal controlling behaviour were more likely to have a child with poor health outcomes. Policymakers must implement a multi-pronged strategy. This includes conducting regular health education sessions in regional languages, enhancing e-health communication, providing financial incentives, and creating a robust legal framework to safeguard women against intimate partner violence. Furthermore, direct engagement with frontline health workers, encompassing women’s empowerment (through education and employment opportunities), and addressing urban-rural health inequalities are imperative.