Inequality in the Utilisation of Maternal Health Care Services in Bihar

Maternal health is crucial for the survival and well-being of children and contributes significantly to the overall health of families. Despite its importance, many mothers lack proper healthcare access, leading to poor quality of life and high maternal mortality rates, particularly in developing countries. According to UNICEF, maternal death during childbirth severely impacts child survival rates, with children who lose their mothers being ten times more likely to die within two years. The global maternal mortality ratio in 2017 was 211 deaths per 100,000 live births, with a stark contrast between developed (11 deaths per 100,000) and developing countries (230 deaths per 100,000). In India, the maternal mortality ratio was 113 deaths per 100,000 live births during 2016-2018 (Government of India, 2020), with states like Bihar, Chhattisgarh, Madhya Pradesh, Odisha, Punjab, Rajasthan, and Uttar Pradesh exceeding the national average.

This study utilizes secondary data from the National Family Health Survey (NFHS) rounds three (2005-06) and four (2015-16) to analyze maternal healthcare service utilization in Bihar, focusing on full antenatal care, skilled attendance at birth, and postnatal care. The NFHS-3 included 124,385 women nationwide, with 3,818 from Bihar, while NFHS-4 covered 699,686 women nationwide and 45,812 from Bihar. Findings indicate persistent high inequality in maternal healthcare service utilization in Bihar, despite a reduction in income-related disparities between 2005-06 and 2015-16. Key predictors of maternal healthcare service utilization include place of residence, birth order, women's education status, caste, and standard of living. Residence, particularly, has significantly influenced the rural-urban disparity in access to maternal healthcare, contributing to persistent inequalities. Addressing these socio-economic inequalities is essential for achieving universal maternal healthcare access and reducing maternal mortality risks.