Sequential impact of components of maternal and child care services on the continuum of care in India

This paper examines the sequential impact of components of maternal and child health care on the continuum of care in India using data from the Indian National Family Health Survey2005-06 to 2015-16. Continuum of care (CoC) for maternal and child health is defined in this paper as the sequential uptake of three key maternal services (antenatal care, institutional delivery, postnatal care for the mother) and progress since the introduction of Janani Suraksha Yojana in 2005. Those women who received all of these three services were classified as full CoC recipients. Odds ratios for achieving CoC were estimated by place of residence, wealth status, education and birth order. Conditional odds ratios were computed to understand the relative impact of each preceding service utilization on the odds of subsequent service uptake. At national level 30.5% and 55.5% women achieved full CoC in 2005-06 and 2015-16, respectively, and the overall progress of CoC during ten years is 25.5% points, with significant variation across states and socioeconomic groups. Full CoC improved from 7.5% to 32.4% among the poorest women, whereas among the richest women, full CoC improved from 70.5% to 75.1%. Similarly, among uneducated women full CoC improved from 11.7% to 35.9% as against 75.1 % to 80.5% among educated mothers during the same period. Further, a greater CoC is observed among parity one women. Besides CoC, the conditionality between various components of CoC indicates that at national level the odds of an institutional delivery with ANC was 9 times higher in the previous period as against 4.5 times higher in the more recent period. Further, women with institutional deliveries comply more with mother’s post-natal care compared with women who did not have institutional deliveries. This again helps increase the likelihood of a child receiving full vaccination.