Inequity in the Utilization of Maternal-Health Care Services in South Asia: Nepal, India and Sri Lanka

To review the inequities in utilization of Skilled Birth Attendants (SBA) and institutional delivery services using “Three Delays framework” to categorize and explain socio economic determinants in Nepal, India and Sri Lanka. Design: This is an article review which adopted narrative synthesis (a mixed method approach). Literature search was conducted from a relevant database including: Scopus, ProQuest and PubMed. The search was performed using developed list of search terms to find out published papers from Nepal, India and Sri Lanka. The paper also used data from Nepal Demographic Health Survey (NDHS, 2011), National Family Health Survey, India (NFHS, 2006) and Sri Lanka Demographic Health Survey (DHS, 2007). Findings: From 438 articles, sixteen studies were included, from Nepal, India and Sri Lanka. Findings were organised under three delays themes: (1) deciding to seek health care by women and/or her family, (2) Reaching health care facility and (3) Receiving adequate and appropriate health care at the facility. The evidence from these studies showed wide variation in use of maternal health services exist both between and within respective countries. These differences are affected by education, distance, lack of transportation, cost of transportation and cost of delivery at hospitals. Key conclusions: This study has shown high variations in the use of maternal health care services in South Asian countries. Nepal and India had lower access and higher inequalities in utilization of SBAs at delivery and institutional delivery by socio-economic determinants compared with Sri Lanka