The Role of Lower-Level Public Health Facilities to Reducing Socioeconomic Disparity in Institutional Deliveries in India: Evidence from the Nationally Representative Datasets, 2005-2021

Guru Vasishtha, International Institute for Population Sciences (IIPS), Mumbai, India
Laxmi Kant Dwivedi, International Institute for Population Sciences (IIPS)

This study examines the role of lower-level public health facilities, such as Primary Health Centers (PHCs) and Community Health Centers (CHCs), in increasing utilization and reducing socioeconomic disparities in institutional deliveries in India. Utilizing data from the three rounds of National Family Health Surveys (NFHS) conducted between 2005-2021, the research analyses the trends and contribution of lower-level health facilities to reducing inequality in institutional delivery across various socioeconomic groups. The findings indicate a substantial increase in the utilization of lower-level health facilities for deliveries, particularly among the poorest households, from 2.8% in 2005 to 44.1% in 2021. Significant disparities persist despite the improvements driven by initiatives like the National Rural Health Mission (NRHM) and Janani Suraksha Yojana (JSY), which offer financial incentives for institutional deliveries. The study highlights that while the rich-poor gap in access to institutional deliveries has narrowed, inequalities remain, particularly in rural and underserved regions. The findings underscore the need for continued policy focus on enhancing the quality and accessibility of primary healthcare services to bridge these gaps. Strengthening lower-level public health facilities is crucial for further reducing maternal and neonatal mortality and promoting health equity across all socioeconomic strata in India.

Keywords: Inequality, Disadvantage and Discrimination, Population Policies, Population and Development, Health and Morbidity

See extended abstract.