Multiple deprivations and maternal care in India.

CONTEXT Research on inequalities in the utilization of maternal health care services is often confined to only the economic domain. Individuals and families living in acute poverty may simultaneously experience multiple dimensions of deprivation, which together may obstruct their access to basic health services. It is important to examine the linkages between multiple deprivations and maternal health care. METHODS Data from the 2005-2006 Indian National Family Health Survey were used to examine ever-married women's receipt of antenatal care, medical assistance during delivery and postnatal care services across three dimensions of deprivation: education, wealth and health. Bivariate analyses, principal component analyses and binomial logistic regression analyses were conducted. RESULTS Thirty-two percent of ever-married Indian women reported being deprived in one of the three dimensions, 18% in two and 7% in all three; 43% were deprived in none. Women deprived in all three dimensions were less likely than those not deprived in any to have received antenatal care (predicted probabilities, 0.3 vs. 0.8) or postnatal care (0.2 vs. 0.7); the likelihood that a birth occurred with medical assistance was smaller for women deprived in three dimensions than for those deprived in none (0.2 vs. 0.8). These patterns held true for all of the larger Indian states. Differentials in utilization of maternal care services across deprivation levels were higher in states where service coverage was low and lower in states where service coverage was high. CONCLUSION More research is needed to understand how multiple deprivations are associated with health inequality across cultures and how to use this knowledge to improve delivery of basic health services.