The National Population Policy adopted in 2000 emphasised the government commitment to safe motherhood, one of the objectives being universal coverage of maternal care. A critical component of safe motherhood is antenatal care (ANC) — access to timely care can go a long way in reducing maternal and infant mortality.
The District Level Household Survey (DLHS), 2007-08 collected data on the utilisation of ANC services for women who had delivered during the three years prior to the survey. According to the survey, 75 per cent of these women had received at least one antenatal care visit during pregnancy. In rural areas, the share was 71 per cent. In urban areas, 87 per cent of the women had received at least one ANC visit during pregnancy. Across India, about 55 per cent of those who had ANC visits received services from government health facilities, 36 per cent from private health facilities and 10 per cent benefited from community-based services that include NGOs, charitable trusts, home visits by trained personnel and so on. In general, government health facilities dominate, across all parameters, except in the case of women with 10 or more years of schooling and women in the highest wealth quintile. When it comes to the weaker sections, of course, the government health facilities are accessed the most.(Click for table)
Yet, there are some states where overall private health facilities account for more than 50 per cent share — Daman & Diu, Kerala, Andhra Pradesh, Punjab, Goa and Karnataka. Bihar and Uttar Pradesh stand out as states with the highest utilisation of community-based services at 33 per cent and 27 per cent respectively; in fact in all other regions, community services account for less than 10 per cent of the ANC services accessed.(Click for graph)
It is important to note that though 75 per cent of Indian women received any ANC services, just 18.8 per cent received the recommended full ANC services, that includes at least three visits for antenatal check-up, at least one tetanus toxoid injection and 100 or more iron and folic acid tablets or equivalent syrup consumed during pregnancy. Goa ranks on top with full ANC services given to 91 per cent of the pregnant women. Kerala and Lakshadweep are next at more than 60 per cent coverage. The disparity is highest in West Bengal, Haryana and Punjab, where full ANC coverage is significantly lower than any ANC coverage. The states that are at the bottom of providing full ANC coverage are Uttar Pradesh and Bihar, where less than 5 per cent of the expectant mothers get the full recommended care. Clearly, in these states, government health facilities are not delivering, while private healthcare, in whatever form it exists, remains out of reach for poor households. This also explains the relatively higher dependence on community-based services in these two states.
It was in 2006 that the government launched the Janani Suraksha Yojana, with special emphasis on low-performing states, identifying the ASHA, the accredited social health activist, as the link between the government and the women. The next DLHS will show how successful this programme has been in raising full coverage of ANC services amongst the underprivileged and reducing inter-state disparity.
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
