Public-private share in maternal health care services utilization in India: A multinomial logistic regression analysis from three consecutive survey data

Background: The Antenatal care and institutional delivery to improve maternal and child health is the prime focus of the time. India, with its large economic diversity, the health care utilization may depend on type of service provider i.e. public or private. The present study estimates the trends in the utilization of public and private maternal health care services and the associated socio-demographic factors, the major focus being Antenatal care and skilled delivery. Methodology: The present population based cross-sectional analysis is performed on the secondary data of India from three rounds of District Level Household Survey (DLHS) conducted in 1998–99, 2002–04 and 2007–08. Indicators for maternal health care utilization are based on full antenatal check up (FANC) as defined by RCH program and skilled institutional delivery attendance (SID) as defined by WHO by the mode of service provider (Public vs Private). Multinomial logistic regression was used for statistical analysis by considering these indicators as the outcome variables treating various socio-demographic factors as independent variables. Result: The urban area, other than SC/ST caste, higher wealth index and more than 10 years of mother's & father's education have high proportion of maternal health care utilization. Lower parent's education have shown lower relative risk ratio of FANC and SID accessibility throughout the survey periods. Wealth indices as a factor of FANC and SID are observed higher in private sectors as compared to public sectors during second and third survey. Women with more pregnancy related problem have chosen private sector for their institutional delivery during all the survey periods. Maternal health programme related initiatives such as when health worker visit for antenatal care and women counselled to go for institutional delivery have shown improvement in terms of accessibility. Conclusion: This study used multinomial logistic regression which attempts to integrate the different socio-economic and demographic factors as well as maternal health related program initiatives by mode of service provider. The analysis strongly brings out the preference for public sector and private sector for seeking maternal services mainly depends on the various socio-economic characterises. Program initiatives clearly demonstrate that accessibility is higher for public sector. However,the improvement in the public sector is stagnating beyond a point across India. Public-private partnership needs to be explored by keeping in mind that the efforts are to be directed more for deprived section of the society.