Peer-reviewed article
Is economic inequality in maternal and child healthcare decreasing in India? Trends between 2005–2006, 2015–2016 and 2019–2021
Rimjhim Bajpai, Abhishek Kumar, Rajib Acharya, Niranjan Saggurti ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined economic inequality in maternal and child healthcare in India over 15 years using data from national surveys in 2005-2006, 2015-2016, and 2019-2021. Coverage of key services—including antenatal care, institutional delivery, postnatal care, and child immunisation—increased across all income groups, with greater improvements among poorer households. While economic inequality in healthcare access narrowed significantly over this period, geographic disparities between states and districts remain substantial.
Key points
- Coverage of all four maternal and child health indicators increased over 15 years across socioeconomic groups
- The poorest segments of the population saw larger absolute gains than the richest, reducing economic inequality
- Inequality in institutional births declined substantially, with the slope index of inequality dropping from 0.76 (2005-2006) to 0.37 (2019-2021)
- Despite progress, geographic disparities persist across Indian states and districts
- Targeted strategies with geographic focus are needed to achieve universal access to reproductive healthcare by 2030
Limitations
The study relies on self-reported data from national surveys and cannot establish causation for why inequality declined. It does not evaluate specific interventions but rather documents trends, so it cannot identify which policies or programmes drove the improvements.
Abstract
OBJECTIVE: This study examined economic inequality in coverage of selected maternal and child healthcare (MCH) indicators in India and its states over the last 15 years. DESIGN: The study analysed last three rounds of the National Family Health Survey data, conducted during 2005-2006, 2015-2016 and 2019-2021. Bivariate analyses, ratio of richest to poorest, slope index of inequality (SII) and multivariate binary logistic regression analyses were used to examine the coverage as well as inequalities in the outcome indicators for India and its states and at district level. PRIMARY OUTCOMES: The outcome variables analysed in the study were full antenatal care, institutional delivery, postnatal care of mothers within 48 hours of delivery, and full immunisation among children. PARTICIPANTS: Women aged 15-49 who had given a birth in the last 5 years before the surveys were unit of analysis for the maternal healthcare indicators, and children aged 12-23 months were unit of the analysis for childhood immunisation. RESULTS: Over the last 15 years, coverage of the MCH indicators has increased in India and across socioeconomic segment of the population, and the absolute increase was higher among the worse-off segments than the better-off. This led to decline in the inequality in coverage of all the MCH indicators. For instance, the value of SII for institutional births decreased from 0.76 in 2005-2006 to 0.45 in 2015-2016 and further to 0.37 in 2019-2021. Although inequality has decreased, geographic disparities persist across states and districts. CONCLUSION: Though substantial improvement was observed, coverage of MCH indicators increased and the economic inequality declined; certain geographies are still characterised with the low coverage and persistent high inequality. This suggests that adding a spatial perspective to the inequality research and targeted strategies is essential for achieving universal access to reproductive healthcare services by 2030 in India.