Poverty and maternal health care utilisation in Maharashtra: associated influences on infant mortality and morbidity

This paper explores the effects of poverty on access to maternal health care services (MHC), linking the use of MHC to two outcomes for the infant; mortality and nutritional status. The paper therefore falls under the overall theme of the international health strand; eliminating disparities in health outcomes. The paper establishes disparities in health outcomes between socio-economic groups in both urban and rural areas. Previous literature has documented an urban-rural dichotomy in infant survival and utilisation of MHC in India but little is known about the variations among socio-economic groups within urban areas. Rates of infant mortality are much higher in poorer sectors of the urban areas, suggesting that some differential utilisation of MHC exist between socio-economic groups. In this paper the Indian National Family Health Survey (1992/93) for Maharashtra is used to model use of antenatal and delivery care and associated influences on infant mortality and morbidity. A composite index is created to examine the influence of standard of living on use of MHC. Findings show that those living in poorer households in rural and urban areas have a lower utilisation of MHC services than those in the higher socio-economic strata. The low level of use of these services is associated with increased neonatal mortality. In addition, infants living in lower socio-economic groups in rural and urban areas have an increased risk of poor nutritional status and neonatal mortality. Learning Objectives: By the end of this session, the participant will be able to: 1. Create a standard of living index based upon socio-economic data collected in standard cross-sectional surveys such as the demographic and health surveys(DHS). 2. Compare maternal and child health outcomes across socio-economic groups within rural and urban settings in Maharashtra. 3. Recognise the barriers to health care utilisation by the poorest socio-economic groups in urban areas. 4. Understand how standard of living influences use of maternal health care and its associated influences with infant nutrition and mortality outcomes in Maharashtra