Towards an understanding of the multilevel factors associated with maternal health care utilization in Uttar Pradesh, India

ABSTRACT

Background: This paper explores the multilevel factors associated with maternal health utilization in India’s most populous state, Uttar Pradesh. 3 key utilization practices: registration of pregnancy, receipt of antenatal care, and delivery at home are examined for district and individual level predictors. The data is based on 5666 household surveys conducted as part of a baseline evaluation of the Uttar Pradesh Technical Support Unit (UPTSU.) program.

Objectives: This intervention aims to assist the Government of Uttar Pradesh in increasing the efficiency, effectiveness, and equity of service delivery across a continuum of reproductive, maternal, new-born, child, and adolescent health (RMNCH+A) outcomes.

Methods: The paper employs multilevel models that control for individuals being nested within districts in order to understand the predictors of maternal health care utilization.

Results: The study identifies several individual-level predictors of health care utilization, including: literacy of the woman, the husband’s schooling, age at marriage, and socio-economic factors. Key predictors of pregnancy registration include husband’s schooling (OR 1.49, 95% CI 1.26–1.76), having a bank account (OR 1.36, 95% CI 1.11–1.68), and owning a house (OR 2.28, 95% CI 1.85–2.80). Factors affecting antenatal care include the woman’s literacy (OR 1.49, 95% CI 1.28–1.73), the respondent having had a job in the last year (OR 1.39, 95% CI 1.10–1.77), and owning a house (OR 2.83, 95% CI 2.27–3.53). Home delivery tends to be associated with woman’s literacy (OR 0.62, 95% CI 0.54–0.72) and marriage age of 15 and younger (OR 1.48, 95% CI 1.26–1.73).

Conclusions: Interventions having equity considerations need to disrupt existing patterns of the health gradient. Successful implementation of such interventions, necessitate understanding the mechanisms that can disrupt the unequal utilization patterns and target domains of disadvantage. Knowledge of key predictors of utilization can aid in the implementation of such complex interventions.

KEYWORDS:

• Maternal health
• health inequities
• evaluation

Responsible Editor Siddhivinayak Hirve, World Health Organisation, Geneva, Switzerland

Responsible Editor Siddhivinayak Hirve, World Health Organisation, Geneva, Switzerland

Acknowledgments

None.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Our study’s protocols were reviewed and approved by the National Rural Health Mission (NRHM) of Uttar Pradesh, PHS-ERB (an independent ethical review board) and the Health Ministry Screening Committee’s (HMSC) Indian Council for Medical Research (ICMR). These protocols were also registered with the Clinical Trial Registry – India (CTRI/2015/09/006219).

Paper context

This paper explores the factors that impede or facilitate the utilization of healthcare services. Three specific utilization practices are explored in India’s most populated State Uttar Pradesh: registration of the pregnancy, receiving any antenatal care and if the delivery was at home. Predictors of utilization include literacy of the mother, husband's schooling, age at first marriage, and socio-economic factors. Knowledge of such predictors can help implement complex interventions that can incorporate equity considerations in healthcare utilization.

Additional information

Funding

This study was supported by the Bill and Melinda Gates Foundation [Grant # OPP1083531].

Notes on contributors

Sanjeev Sridharan

SS and AD did the analysis. SS wrote the first draft of the article. Each of the other authors AD, AS, DC, KS, KH and RG contributed to the writing of the document and further analysis as needed.