Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens

Despite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India. Utilising survey-weighted logistic regress...

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Vydané v:Journal of global health Ročník 10; číslo 2; s. 021011
Hlavní autori: Ward, Victoria C, Weng, Yingjie, Bentley, Jason, Carmichael, Suzan L, Mehta, Kala M, Mahmood, Wajeeha, Pepper, Kevin T, Abdalla, Safa, Atmavilas, Yamini, Mahapatra, Tanmay, Srikantiah, Sridhar, Borkum, Evan, Rangarajan, Anu, Sridharan, Swetha, Rotz, Dana, Bhattacharya, Debarshi, Nanda, Priya, Tarigopula, Usha Kiran, Shah, Hemant, Darmstadt, Gary L
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Scotland Edinburgh University Global Health Society 01.12.2020
International Society of Global Health
Predmet:
Behavior
Breast feeding
Breastfeeding & lactation
Child Health
Childrens health
Drinking water
Family planning
Female
Global health
Health Behavior
Health disparities
Health Promotion
Health services
Health surveys
Healthcare Disparities
Households
Humans
India
Infant
Infant Health
Infant, Newborn
Intersectionality
Male
Maternal & child health
Maternal Health
Maternal Health Services
Newborn babies
Nutrition
Nutritional Status
Population
Pregnancy
Prenatal care
Quality control
Reproductive Health
Research Theme 6: Learning from Ananya Program in Bihar
Skin care
Social exclusion
Socioeconomic factors
Womens health
India
Bihar India
ISSN:2047-2978, 2047-2986, 2047-2986
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Shrnutí:Despite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India. Utilising survey-weighted logistic regression, we estimated programmatic impact using difference-in-difference estimators from Mathematica data collected at the beginning (2012, n = 10 174) and after two years of program implementation (2014, n = 9611). We also examined changes in disparities over time using eight rounds of Community-based Household Surveys (CHS) (2012-2017, n = 48 349) collected by CARE India. At baseline for the Mathematica data, least marginalised women generally performed desired health-related behaviours more frequently than the most marginalised. After two years, most disparities persisted. Disparities increased for skilled birth attendant identification [+16.2% (most marginalised) vs +32.6% (least marginalized),  < 0.01) and skin-to-skin care (+14.8% vs +20.4%,  < 0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9,  < 0.01). For the CHS data, odds ratios compared the most to the least marginalised women as referent. Results demonstrated that disparities were most significant for indicators reliant on access to care such as delivery in a facility (OR range: 0.15 to 0.48) or by a qualified doctor (OR range: 0.08 to 0.25), and seeking care for complications (OR range: 0.26 to 0.64). Disparities observed at baseline generally persisted throughout program implementation. The most significant disparities were observed amongst behaviours dependent upon access to care. Changes in disparities largely were due to improvements for the least marginalised women without improvements for the most marginalised. Equity-based assessments of programmatic impacts, including those of universal health approaches, must be undertaken to monitor disparities and to ensure equitable and sustainable benefits for all. ClinicalTrials.gov number NCT02726230.
Bibliografia:ObjectType-Article-1
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ISSN:2047-2978
2047-2986
2047-2986
DOI:10.7189/jogh.10.021011