Maternity or catastrophe: A study of household expenditure on maternal health care in India

Abstract

Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in urban and rural areas separately. Additionally, it measures the effect of maternal health care expenditure on poverty incidence and examines the factors associated with such impoverishment due to maternal health care payments. We found that maternal health care expenditure in urban households was almost twice that of rural households. A little more than one third households suffered catastrophic payments in both urban and rural areas. Rural women from scheduled tribes (ST) had more catastrophic head counts than ST women from urban areas. On the other hand, the catastrophic head count was greater among illiterate women living in urban areas compared to those living in rural areas. After adjusting for out-of-pocket maternal health care expenditure, the poverty in urban and rural areas increased by almost equal percentage points (20% in urban areas versus 19% in rural areas). Increasing education level, higher consumption expenditure quintile and higher caste of women was associated with increasing odds of impoverishment due to maternal health care expenditure. To reduce maternal health care expenditure induced poverty, the demand-side maternal health care financing programs and policies in future should take into consideration all the costs incurred during prenatal, delivery and postnatal periods and focus not only on those women who suffered catastrophic expenditure and plunged into poverty but also those who forgo maternal health care due to their inability to pay.

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Mukherjee, S. , Singh, A. and Chandra, R. (2013) Maternity or catastrophe: A study of household expenditure on maternal health care in India. Health, 5, 109-118. doi: 10.4236/health.2013.51015.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Starrs, A. (2001) Skilled attendance at delivery: A review of the evidence. The Interagency Group for Safe Motherhood, Family Care International, New York.
[2] Hogan, M.C., Foreman, K.J., Naghavi, M., et al. (2010) Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards Millennium Development Goal 5. Lancet, 375, 1609-1623. doi:10.1016/S0140-6736(10)60518-1
[3] World Health Organisation (WHO) (2005) The World Health Report 2005: Make every mother and child count. The World Health Organization, Geneva. http://www.who.int/whr/2005/en/
[4] Dhakal, S., Chapman, G.N., Simkhada, P.P., van Teijlingen, E.R., Stephens, J., et al. (2007) Utilization of postnatal care among rural women in Nepal. BMC Pregnancy and Child health, 7, 1-9.
[5] International Institute for Population Sciences (IIPS) and ORC Macro International (2007) National Family Health Survey (NFHS-3), 2005-2006. IIPS, Mumbai.
[6] Hussain, Z. (2011) Health of the national rural health mission. Economic & Political Weekly, 46, 53-60.
[7] Garg, S., Singh, R.M. and Grover, M. (2012) India’s health workforce: Current status and the way forward. The National Medical Journal of India, 25, 111-113.
[8] National Rural Health Mission (NRHM) (2011) Bulletin on Rural Health Statistics in India 2011. Ministry of Health and Family Welfare (Statistics Division), Government of India. http://nrhm-mis.nic.in/Publications.aspx
[9] Mohanty, S. and Srivastava, A. (2012) Out-of-pocket expenditure on institutional delivery in India. Health Policy and Planning. doi:10.1093/heapol/czs057
[10] McCord, C., Premkumar, R., Arole, S. and Arole, R. (2001) Efficient and effective emergency obstetric care in a rural Indian community where most deliveries are at home. International Journal of Gynaecology and Obstetrics, 75, 297-307. doi:10.1016/S0020-7292(01)00526-4
[11] Balaji, R., Dilip, T.R. and Duggal, R. (2003) Utilization of and expenditure on delivery care services: Some observations from Nashik District, Maharashtra. Regional Health Forum, 7, 33-41.
[12] Duggal, R. (2004) The political economy of abortion in India: Cost and expenditure patterns. Reproductive Health Matters, 12, 130-137. doi:10.1016/S0968-8080(04)24012-5
[13] Sharma, S., Smith, S., Pine, M. and Winfrey, W. (2005) Formal and informal reproductive health care user fees in Uttaranchal, India. Policy Project, Washington.
[14] Bonu, S., Bhusan, I., Rani, M. and Anderson, I. (2009) Incidence and correlates of catastrophic maternal health care expenditure in India. Health Policy and Planning, 24, 445-456. doi:10.1093/heapol/czp032
[15] Ghosh, S. (2010) Catastrophic payments and impoverishment due to out-of-pocket health spending: The effects of recent health sector reforms in India Asia Health Policy Program. Working Paper #15. http://asiahealthpolicy.stanford.edu
[16] Xu, K., Ravndal, F., Evans, D.B. and Carrin, C. (2009) Assessing the reliability of household expenditure data: Results of the World Health Survey. Health Policy, 91, 297-305. doi:10.1016/j.healthpol.2009.01.002
[17] Wagstaff, A. and vanDoorslaer, E. (2003) Catastrophe and impoverishment in paying for health care: With applications to Vietnam 1993-1998. Health Economics, 12, 921- 932. doi:10.1002/hec.776
[18] Kawabata, K., Xu, K. and Carrin, G. (2002) Preventing impoverishment through protection against catastrophic health expenditure. The Bulletin of the World Health Organization, 80, 612.
[19] Limwattananon, S., Tang-charoensathie, V. and Prakongsa, P. (2007) Catastrophic and poverty impacts of health payments: Results from national household surveys in Thailand. The Bulletin of the World Health Organization, 85, 600-606. doi:10.2471/BLT.06.033720
[20] Mendola, M. (2007) The impoverishing effect of adverse health events: Evidences from Western Balkans. Policy Research Working Paper No 4444. The World Bank, Washington.
[21] Wagstaff, A. and van Doorslaer, E. (2003) Catastrophe and impoverishment in paying for health care: With applications to Vietnam 1993-98. Health Economics, 12, 921-934. doi:10.1002/hec.776
[22] O’Donnell, O., van Doorslaer, E., Rannan-Eliya, R., et al (2007) The incidence of public spending on health care: Comparative evidence from Asia. World Bank Economic Review, 21, 93-123. doi:10.1093/wber/lhl009
[23] Navaneetham, K. and Dharma-lingam, A. (2000) Utilization of maternal health care services in South India, Centre for Development Studies. Trivendrum Working Papers 307, Centre for Development Studies, Triven-drum.
[24] National Sample Survey Organization (NSSO) (2006) Morbidity, health care and condition of the aged: NSSO 60th round (January-June 2004). Ministry of Statistics and Program Implementation, Government of India, New Del-hi.
[25] O’Donnell, O., Van Doorslaer, E., Wagstaff, A. and Lindelow, M. (2008) Analyzing health equity using household survey data: A guide to techniques and their implementation. The World Bank, Washington.
[26] Ministry of Health and Family Welfare (MOHFW) (2006) Janani Surakhsha Yojana—Features and frequently asked questions. Government of India. http://jknrhm/PDF/JSR.pdf

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