Unlocking Equality in Maternal and Child Health- the Power of Providers, Place, and Time in India

Arpana Kullu, TATA INSTITUTE OF SOCIAL SCIENCES
Priyanka Dixit, TISS

Socio-economic inequalities exacerbate the adverse impacts on health. This study examines the role community based strategy closer to communities in addressing socio-economic and caste-based disparities in maternal and child healthcare (MCH) services in India. Methodology- We explore the role of three key elements: providers (CHWs), place (home-based or facility-based care), and time (timing of contact with provider during pregnancy) on the reduction of gap in MCH service utilisation between marginalised and non-marginalised communities. Using data from three rounds of the National Family Health Survey (NFHS), covering the periods 2005-2021. Findings - Our findings reveal that the presence of CHWs significantly increased MCH service utilization, especially among marginalized communities, thus narrowing disparities in healthcare access. The predictive probability analysis shows that CHWs' involvement reduced the service utilization gap between the poorest and richest households across critical health indicators, such as early antenatal registration and institutional deliveries. Furthermore, the positive effects of CHWs are more pronounced during the earlier period (2005-2015) with sustained improvements in the later years (2015-2019). This study highlights the essential role of CHWs in reducing health inequities and emphasizes the need for strengthening community-based interventions to achieve universal MCH coverage in India.

Keywords: Inequality, Disadvantage and Discrimination, Sexual and Reproductive Health and Rights, Population and Development, Data and Methods

See extended abstract.