Indicus Analytics: Delivery failed notice

India’s healthcare system has not been able to ensure safe deliveries for women in socially-disadvantaged groups.

Newborn and maternal health depend crucially on the healthcare received during pregnancy and delivery. The access to safe delivery facilities, especially with skilled professional assistance at hand, reduces the risk of maternal and infant mortality. Multiple factors influence the access to skilled services for child delivery. For example, 43.3 per cent of rural women have safe deliveries, while the proportion is 75.6 per cent in urban areas. Education is also a significant determinant, with 31 per cent of illiterate women and 85 per cent of those with schooling of ten years or more having safe deliveries.

 

It is the socially-disadvantaged groups that bear the brunt of low education and income, and social group differentials in morbidity and utilisation of healthcare services stand out as glaring lacunae in the public health system.(Click here for graph)

According to the third District Level Household and Facility Survey (DLHS) of 2007-08, around 38 per cent of Scheduled Tribes (STs) and 48 per cent of Scheduled Castes (SCs) accessed safe delivery facilities, while the corresponding proportion among the general population was higher at 58 per cent. Even as all groups reported an increase in the use of safe delivery facilities between 2002-04 and 2007-08, the gap between other groups and the socially-disadvantaged ones grew, albeit marginally, indicating that disparity remains a cause for concern.

The proportion of SC women receiving safe delivery facilities varies widely across states. In nine states, the proportion of SC women with safe deliveries exceeded 80 per cent — Lakshadweep, Goa, Kerala, Puducherry, Tamil Nadu, Dadra & Nagar Haveli, Manipur, Andhra Pradesh and Mizoram. At the other end, Jharkhand and Uttar Pradesh reported less than a quarter of SC women availing of safe delivery facilities. Similarly, the proportion of ST women with safe deliveries ranged from a mere 14 per cent in Jharkhand to 100 per cent in Goa, Puducherry and Chandigarh. Meghalaya, Orissa, Chhattisgarh, Bihar, Uttar Pradesh and Jharkhand reported less than 30 per cent of ST women having safe deliveries; this reflects the inadequacies of the health system in these states that have a considerable share of people from socially-disadvantaged groups in its population.

The inequality among social groups varies widely across states. For instance, the gap between SCs and Others is 20 percentage points in Punjab, while it is marginal in states like Lakshadweep, Kerala and Puducherry. There are some states and Union Territories like Mizoram, Dadra & Nagar Haveli, Meghalaya, Tripura, Arunachal Pradesh, Assam and Goa where SC women are better off in terms of availing safe delivery facilities than other groups. However, Tripura stands out as the only state with a sizeable share of SC population. In Manipur, Andhra Pradesh, Orissa and Dadra & Nagar Haveli the gap between STs and Others is more than 40 percentage points, while in Maharashtra, Gujarat and Madhya Pradesh, the disparity is more than 30 percentage points.

In general, a low disparity between social groups points to a good healthcare system, DLHS data show that despite government programmes targeting the socially-disadvantaged groups, the situation has not improved appreciably. So, even as the smaller states and Union Territories have performed relatively better on this health indicator, a majority of Indian women belonging to socially-disadvantaged groups continue to lack access to skilled healthcare.

Indian States Development Scorecard is a weekly feature by Indicus Analytics that focuses on the progress in India and the states across various socio-economic parameters

sumita@indicus.net