Inequality in maternal health-care services and safe delivery in eastern India.

BACKGROUND The target for Millennium Development Goal 5 (MDG-5) is to reduce the maternal mortality ratio by three quarters between 1990 and 2015. The United Nations 2014 report on MDG-5 concluded that little progress had been made in the South Asian countries, including India, which accounts for 17% of all maternal deaths globally. In resource-poor economies with widespread disparities even within the same country, it is very important to explore inequalities in safe delivery during childbirth by key socioeconomic factors in order to provide insights for future programming and policy actions. METHODS Data from the Indian District Level Household and Facility Survey 3 were analysed to examine inequalities in safe delivery in eastern India. Univariate and multivariate logistic regression models were used. RESULTS There were substantial inequalities in safe delivery by asset quintile, education of the woman and her husband, area of residence (rural or urban), religion and age at marriage (<18 years or ≥18 years); however, not all inequalities were the same. After adjusting for education levels of both parents, area of residence, religion and mother's age at marriage, the odds of having a safe delivery were almost eightfold higher for those in the highest asset quintiles compared with those in the lowest quintiles. The odds for a safe pregnancy were three times higher for educated women compared with a base case of no education. The chances of having a safe delivery were twofold higher for women living in urban areas compared with those in rural areas (odds ratio 2.04, 95% confidence interval 1.91-2.17). CONCLUSION Addressing inequalities in maternal health should be viewed as a central policy goal together with the achievement of MDG-5 targets. In addition to following the indirect route of improving maternal health via poverty alleviation, direct interventions are needed urgently. Women's education has a strong potential to improve access for poor pregnant women to safe delivery services and to reduce disparities in maternal health outcomes in resource-poor economies.