Conceived and designed the experiments: PKS RKR. Performed the experiments: PKS RKR. Analyzed the data: PKS. Contributed reagents/materials/analysis tools: PKS RKR MA LS. Wrote the paper: PKS RKR MA LS.
The authors have declared that no competing interests exist.
Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed.
Using the data from third wave of National Family Health Survey (2005–06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15–19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions.
The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to poor and specific sub-groups of the population in rural areas to address the unmet need for maternal healthcare service utilization.
Maternal healthcare remains a major challenge to the global public health system, especially in developing countries
The theoretical framework represented by Thaddeus and Maine (1994) referred to socioeconomic/cultural factors (women's status in household and society, educational and economic status of women etc.), accessibility to facility (distance, transportation etc.) and availability of quality of care (availability of staff and equipment in health facility centre) as the crucial factors behind maternal morbidity and mortality
The perspective of maternal healthcare for adolescent mothers is crucial because early sexual activity and childbearing accelerates the risk of maternal as well as child morbidity or/and mortality. These phenomena are applicable for both developed countries like the United States
Adolescent mothers are more likely to have severe delivery complications resulting in high morbidity as well as mortality. There is a serious dearth of empirical research in India on the utilization of maternal healthcare services in rural settings by adolescents in the age group 15–19 years. Some studies
This paper attempts to assess the factors associated with selected maternal healthcare indicators with reference to adolescent mothers in the age group 15–19 years living in rural India. Three key indicators in healthcare are measured: adolescent women receiving full antenatal care, those who had safe delivery and adolescent women who received postnatal care within 42 days of delivery. It is hoped that the findings will help ongoing program and policy efforts to identify the key factors in the provision and utilization of maternal healthcare for rural adolescent women.
The present study utilizes data from the third round of the Indian counterpart of Demographic and Health Survey, popularly known as National Family Health Survey carried out during 2005–06
A multistage stratified sampling method was used to create a sample, representing individuals from all 29 Indian states
The present study examines the utilization of maternal healthcare services among married adolescent mothers in rural areas. The term, ‘adolescent mother’ refers only to ever married women who have had the experience of childbirth in their teens (15–19) during the five years preceding the survey date. In NFHS-3, out of all ever-married women interviewed 23,955 were in the age group 15–19 years. The data recorded 56,438 births that occurred in the five years preceding the survey. Among the women interviewed, 5,253 were found to have had experience of childbirth in their adolescence (aged 15–19 years) during the five years preceding the survey date. However the present study focused on rural areas, where about 80% (3,599) of the total adolescent women (5,253) had experience of childbirth in their adolescence. Therefore, the present study takes into consideration the responses of those adolescent mothers who had experience of childbirth in their adolescence (aged 15–19 years) during the five years preceding the survey date and residing in rural areas.
The study measures three outcome variables namely, full antenatal care, safe delivery and postnatal care as the indicators of maternal healthcare utilization. The three selected indicators of maternal healthcare utilization and their components are considered on the basis of guidelines developed by the Ministry of Health and Family Welfare, Government of India and the World Health Organization
Socioeconomic and demographic predictors such as age of the woman at birth, women's education, husband's education, religion, social group, women's autonomy, mass media exposure, wealth quintile, family structure, birth order and interval, status of the child, visit of health provider and region of residence were included as predictor variables in the study. Mother's age at birth was categorized into <18 years and 18–19 years of age. The educational level of the women and their husbands was defined using years of schooling and they were grouped into illiterate, literate but below primary, primary but below middle school, middle but below high school, and high school and above. The religion of the mother was categorized as Hindu, Muslim, and others (Sikh, Christians, Buddhist and others). Identification of the social group was based on the women's self-reporting as others, Scheduled Castes (SCs), Scheduled Tribes (STs) and Other Backward Classes (OBCs). The Central Government of India classifies certain castes/tribes based on their historical disadvantage in social and economic positions
Women's autonomy was computed by taking three dimensions into account, namely, decision-making authority, women's mobility (freedom to visit places unescorted) and access to economic resources
The survey provides the information on recent contact of respondents with different health workers. The term ‘health worker visit’ encompasses a visit by any health worker namely, Auxiliary Nurse-Midwives (ANM), Lady Health Visitors (LHVs),
To identify the factors associated with maternal healthcare utilization among adolescent women, bi-variate and multivariate analyses were performed. Bi-variate analyses were performed to examine the nature of association between utilization of maternal healthcare services by selected socioeconomic and demographic background characteristics. However, binary logistic regression was applied to investigate which factors best explain and predict the utilization of all three maternal health outcomes. Instead of the linear probability model, logistic regression function is preferable to fit some kind of sigmoid curve when the response variable is dichotomous (i.e., binary or 0–1) and that reasonably portrays the reality about outcome events. The binary response (y, full antenatal care received or not; undergone safe delivery care or not; received postnatal care or not) for each individual was related to a set of categorical predictors, X, and a fixed effect by a logit link function as following.
The probability of an individual who had received full antenatal care or undergone safe delivery care or received postnatal care is πi. The parameter β0 estimates the log odds of full antenatal care or safe delivery care or postnatal care for the reference group, and the parameter β estimates with maximum likelihood, the differential log odds of full antenatal or safe delivery or postnatal care are associated with the predictor X, as compared to the reference group. It is worth mentioning, ε represents the error term in the model. In the bi-variate analysis, using the Chi-square test, significant variables were identified and those were included in the binary logistic regression model. The results of logistic regression are presented by estimated odds-ratio with 95% Confidence Interval (CI). The whole analysis was performed using SPSS version 15.0
This study uses the National Family Health Survey dataset which is available to the researchers upon request at <
Selected indicators | 15–19 |
20 and above |
Total |
Mean age at marriage | 15.1 | 17.1 | 17.3 |
Mean age at first birth | 16.8 | 19.5 | 19.4 |
Mean highest years of schooling | 3.4 | 3.9 | 4.2 |
% of partners with high school education and above | 22.3 | 26.8 | 25.0 |
% with no mass media exposure | 35.0 | 38.3 | 30.4 |
% belonging to the poorest wealth quintile | 32.8 | 28.2 | 31.4 |
% children stunting | 52.4 | 47.0 | 47.6 |
% children suffering from diarrhea | 14.5 | 10.5 | 11.0 |
% currently not using any contraceptive | 71.3 | 56.0 | 58.8 |
% experienced massive vaginal bleeding after birth | 15.0 | 11.0 | 13.0 |
|
|
|
|
Note:
Includes rural samples only.
Includes both urban and rural samples.
Background characteristics | % | n |
|
||
<18 | 61.9 | 2180 |
18–19 | 38.1 | 1419 |
|
||
Illiterate | 48.5 | 1612 |
Literate but below primary | 10.1 | 395 |
Primary but below middle | 21.5 | 787 |
Middle but below high school | 12.5 | 527 |
High school and above | 7.4 | 278 |
|
||
Illiterate | 30.9 | 1057 |
literate but below primary | 8.7 | 333 |
Primary but below middle | 18.9 | 702 |
Middle but below high school | 19.2 | 726 |
High school and above | 22.3 | 781 |
|
||
Hindu | 82.5 | 2750 |
Muslim | 14.5 | 501 |
Others | 3.0 | 348 |
|
||
Others | 20.9 | 747 |
Scheduled Castes (SCs) | 24.1 | 741 |
Scheduled Tribes (STs) | 12.6 | 671 |
Other Backward Classes (OBCs) | 42.3 | 1271 |
|
||
Low | 79.4 | 2738 |
High | 20.6 | 859 |
|
||
No exposure | 35.0 | 1139 |
Any exposure | 65.0 | 2460 |
|
||
Poorest | 32.8 | 974 |
Poorer | 27.4 | 1071 |
Middle | 24.0 | 915 |
Richer | 12.4 | 482 |
Richest | 3.4 | 157 |
|
||
Nuclear | 31.1 | 1012 |
Joint | 68.9 | 2180 |
|
||
Birth order 1 | 63.0 | 2303 |
Birth order-2/3 and interval < = 24 | 18.0 | 640 |
Birth order-2/3 and interval >24 | 19.0 | 656 |
|
||
Wanted | 85.5 | 3029 |
Unwanted | 14.5 | 567 |
|
||
No | 63.1 | 2348 |
Yes | 36.9 | 1251 |
|
||
South | 16.4 | 548 |
North | 9.2 | 481 |
Central | 25.2 | 803 |
East | 35.1 | 881 |
Northeast | 4.4 | 614 |
West | 9.8 | 272 |
|
|
Note: All ‘n’ are unweighted. Total may not be equal due to some missing cases.
To identify the factors associated with the utilization of maternal healthcare services, namely, full antenatal care, safe delivery and postnatal care, we examined the bi-variate differential of the selected socioeconomic and demographic characteristics.
Background characteristics | Full antenatal care | Safe delivery | Postnatal care |
|
(4.790) |
(0.446)ns | (1.110)ns |
<18 | 13.0 | 45.3 | 33.9 |
18–19 | 15.1 | 46.2 | 35.3 |
|
(259.469) |
(549.670) |
(316.619) |
Illiterate | 6.9 | 31.3 | 24.0 |
Literate but below primary | 16.7 | 48.1 | 36.3 |
Primary but below middle | 18.6 | 54.7 | 41.1 |
Middle but below high school | 19.2 | 61.8 | 46.9 |
High school and above | 31.8 | 82.5 | 60.3 |
|
(76.994) |
(250.827) |
(78.635) |
Illiterate | 8.3 | 32.8 | 27.5 |
Literate but below primary | 12.3 | 38.1 | 31.8 |
Primary but below middle | 15.4 | 45.9 | 37.1 |
Middle but below high school | 15.5 | 51.6 | 34.7 |
High school and above | 19.1 | 60.9 | 42.8 |
|
(3.285)ns | (29.492) |
(13.712) |
Hindu | 13.5 | 47.1 | 35.1 |
Muslim | 14.3 | 36.8 | 29.5 |
Others | 18.3 | 48.2 | 42.3 |
|
(32.821) |
(114.951) |
(65.487) |
Others | 17.7 | 56.7 | 45.3 |
Scheduled Castes (SCs) | 10.8 | 40.1 | 31.4 |
Scheduled Tribes (STs) | 9.9 | 33.3 | 31.3 |
Other Backward Classes (OBCs) | 14.6 | 48.3 | 33.1 |
|
(0.821)ns | (7.278) |
(7.558) |
Low | 13.5 | 44.7 | 33.6 |
High | 14.6 | 49.2 | 38.0 |
|
(84.544) |
(219.472) |
(151.418) |
No exposure | 7.9 | 32.0 | 23.7 |
Any exposure | 16.9 | 53.0 | 40.3 |
|
(224.383) |
(497.739) |
(306.121) |
Poorest | 7.0 | 29.2 | 23.1 |
Poorer | 10.5 | 41.1 | 29.8 |
Middle | 17.5 | 54.4 | 41.4 |
Richer | 25.3 | 67.7 | 50.7 |
Richest | 32.6 | 88.1 | 67.6 |
|
(0.145)ns | (24.592) |
(3.613) |
Nuclear | 13.2 | 39.9 | 32.0 |
Joint | 13.6 | 47.6 | 34.8 |
|
(16.078) |
(200.393) |
(41.750) |
Birth order 1 | 15.1 | 52.6 | 37.4 |
Birth order-2/3 and interval < = 24 | 10.4 | 38.6 | 32.8 |
Birth order-2/3 and interval >24 | 12.4 | 29.2 | 26.7 |
|
(1.834)ns | (0.184)ns | (0.013)ns |
Wanted | 13.5 | 45.8 | 34.5 |
Unwanted | 15.3 | 44.9 | 34.7 |
|
(15.942) |
(0.158)ns | (19.140) |
No | 12.3 | 45.4 | 32.3 |
Yes | 16.2 | 46.0 | 38.2 |
|
(337.076) |
(492.363) |
(811.924) |
South | 32.0 | 73.7 | 70.4 |
North | 11.6 | 50.0 | 37.3 |
Central | 5.8 | 33.1 | 18.2 |
East | 11.8 | 37.9 | 26.5 |
Northeast | 9.3 | 30.8 | 16.9 |
West | 14.5 | 61.1 | 49.8 |
|
|
|
|
Note: Figures in parentheses are the Chi-square statistics; χ2 test applied for each variable.
Level of significance:
p<0.10;
p<0.05;
p<0.01. ns: not significant.
The utilization of all three maternal healthcare services was observed to increase with the increase in wealth quintile. For instance, only 7% of rural adolescent mothers belonging to the poorest wealth quintile received full antenatal care, while this proportion was found to be 33% among adolescents from the richest wealth quintile. A similar pattern was observed where 29% and 23% of the women belonging to the poorest wealth quintile utilized safe delivery and postnatal care respectively, compared to 88% and 68% from the richest wealth quintile. Adolescent women residing in joint families utilized more safe delivery care (48%). The utilization of full antenatal care (15%), safe delivery (53%) and postnatal care (37%) was higher among those women with first order child birth than with those who had had previous experiences of childbirth. The rates of full antenatal care (16%) and postnatal care (38%) were observed to be high among women whom health providers had visited during pregnancy. Adolescent women from the South region were found to be utilizing maternal healthcare services more than the women from other regions. However, the lowest utilization of full antenatal care (6%) was observed in the Central region. Safe delivery (31%) and postnatal care (17%) was least utilized by adolescent women belonging to the Northeast region.
Multivariate results for full antenatal care utilization presented in
Covariates | Odds ratio | 95% CI |
|
||
<18® | 1.000 | |
18–19 | 1.069ns | 0.893–1.279 |
|
||
Illiterate® | 1.000 | |
Literate but below primary | 2.003 |
1.483–2.707 |
Primary but below middle | 2.152 |
1.686–2.748 |
Middle but below high school | 2.123 |
1.580–2.851 |
High school and above | 2.848 |
2.033–3.991 |
|
||
Illiterate® | 1.000 | |
Literate but below primary | 1.419 |
0.994–2.024 |
Primary but below middle | 1.409 |
1.070–1.856 |
Middle but below high school | 1.436 |
1.080–1.909 |
High school and above | 1.354 |
1.015–1.807 |
|
||
Others® | 1.000 | |
Scheduled Castes (SCs) | 0.827ns | 0.637–1.075 |
Scheduled Tribes (STs) | 0.872ns | 0.627–1.214 |
Other Backward Classes (OBCs) | 0.858ns | 0.690–1.068 |
|
||
No exposure® | 1.000 | |
Any exposure | 1.092ns | 0.872–1.366 |
|
||
Poorest® | 1.000 | |
Poorer | 1.139ns | 0.871–1.491 |
Middle | 1.447 |
1.098–1.907 |
Richer | 1.827 |
1.326–2.518 |
Richest | 2.582 |
1.628–4.094 |
|
||
Birth order 1® | 1.000 | |
Birth order-2/3 and interval < = 24 | 0.634 |
0.494–0.814 |
Birth order-2/3 and interval >24 | 0.855ns | 0.674–1.083 |
|
||
No® | 1.000 | |
Yes | 1.430 |
1.200–1.703 |
|
||
South® | 1.000 | |
North | 0.250 |
0.177–0.352 |
Central | 0.147 |
0.110–0.195 |
East | 0.318 |
0.254–0.399 |
Northeast | 0.259 |
0.156–0.429 |
West | 0.267 |
0.197–0.363 |
Note: ®:Reference Category.
Level of significance:
p<0.10;
p<0.05;
p<0.01. ns: not significant.
Results of the multivariate analysis for safe delivery care are presented in
Covariates | Odds ratio | 95% CI |
|
||
Illiterate® | 1.000 | |
Literate but below primary | 1.747 |
1.384–2.204 |
Primary but below middle | 2.010 |
1.674–2.414 |
Middle but below high school | 2.123 |
1.682–2.679 |
High school and above | 3.876 |
2.715–5.533 |
|
||
Illiterate® | 1.000 | |
Literate but below primary | 0.923ns | 0.708–1.204 |
Primary but below middle | 1.239 |
1.013–1.515 |
Middle but below high school | 1.409 |
1.142–1.738 |
High school and above | 1.210 |
0.966–1.514 |
|
||
Hindu® | 1.000 | |
Muslim | 0.652 |
0.513–0.828 |
Others | 0.746ns | 0.498–1.119 |
|
||
Others® | 1.000 | |
Scheduled Castes (SCs) | 0.613 |
0.491–0.765 |
Scheduled Tribes (STs) | 0.496 |
0.382–0.642 |
Other Backward Classes (OBCs) | 0.714 |
0.587–0.869 |
|
||
Low® | 1.000 | |
High | 1.174 |
0.986–1.397 |
|
||
No exposure® | 1.000 | |
Any exposure | 1.289 |
1.105–1.503 |
|
||
Poorest® | 1.000 | |
Poorer | 1.206 |
1.008–1.444 |
Middle | 1.376 |
1.125–1.685 |
Richer | 1.680 |
1.286–2.196 |
Richest | 3.610 |
1.091–5.182 |
|
||
Nuclear® | 1.000 | |
Joint | 0.967ns | 0.824–1.134 |
|
||
Birth order 1® | 1.000 | |
Birth order-2/3 and interval < = 24 | 0.487 |
0.407–0.585 |
Birth order-2/3 and interval >24 | 0.321 |
0.265–0.388 |
|
||
South® | 1.000 | |
North | 0.274 |
0.204–0.367 |
Central | 0.154 |
0.122–0.195 |
East | 0.218 |
0.175–0.272 |
Northeast | 0.104 |
0.069–0.156 |
West | 0.371 |
0.281–0.490 |
Note: ®: Reference Category.
Level of significance:
p<0.10;
p<0.05;
p<0.01. ns: not significant.
The utilization of safe delivery care increases with the level of women's education. Compared to uneducated rural adolescent women, those who had completed high school education and above, were more likely to utilize safe delivery care (OR = 3.876, CI = 2.715–5.533). The likelihood of using safe delivery was observed to be low among women belonging to the Muslim religion (OR = 0.652, CI = 0.513–0.828) compared to women belonging to the Hindu religion. The probability of utilizing safe delivery was found to be less likely among STs (OR = 0.496, CI = 0.382–0.642), SCs (OR = 0.613, CI = 0.491–0.765) and OBCs (OR = 0.714, CI = 0.587–0.869) than among women from the other social groups. Women who had exposure to mass media were more likely to utilize safe delivery care than women who did not have any mass media exposure (OR = 1.289, CI = 1.105–1.503). Economic status was also found to be an important significant determinant in the utilization of safe delivery care. Adolescent women from the richer and richest wealth quintiles were 1.7 (CI = 1.286–2.196) and 3.6 times (CI = 1.091–5.182) more likely to use safe delivery care respectively compared to those from the poorest wealth quintiles. The probability of safe delivery care was found to be less likely among women who had birth order 2/3 and birth interval >24 months than among women who experienced their first childbirth (OR = 0.321, CI = 0.265–0.388). The regional variation shows that compared to the south region, the odds of utilizing safe delivery care were observed to be the lowest in the northeast region (OR = 0.104, CI = 0.069–0.156), followed by the central (OR = 0.154, CI = 0.122–0.195) and east regions (OR = 0.218, CI = 0.175–0.272).
Covariates | Odds ratio | 95% CI |
|
||
Illiterate® | 1.000 | |
Literate but below primary | 1.417 |
1.112–1.806 |
Primary but below middle | 1.588 |
1.309–1.927 |
Middle but below high school | 1.912 |
1.501–2.434 |
High school and above | 1.917 |
1.399–2.627 |
|
||
Illiterate® | 1.000 | |
Literate but below primary | 1.059ns | 0.804–1.394 |
Primary but below middle | 1.286 |
1.042–1.587 |
Middle but below high school | 1.070ns | 0.855–1.339 |
High school and above | 1.026ns | 0.811–1.297 |
|
||
Hindu® | 1.000 | |
Muslim | 0.877ns | 0.686–1.121 |
Others | 0.918ns | 0.618–1.365 |
|
||
Others® | 1.000 | |
Scheduled Castes (SCs) | 0.693 |
0.555–0.865 |
Scheduled Tribes (STs) | 0.706 |
0.545–0.915 |
Other Backward Classes (OBCs) | 0.584 |
0.481–0.709 |
|
||
Low® | 1.000 | |
High | 1.106ns | 0.926–1.320 |
|
||
No exposure® | 1.000 | |
Any exposure | 1.230 |
1.044–1.449 |
|
||
Poorest® | 1.000 | |
Poorer | 1.021ns | 0.841–1.239 |
Middle | 1.183ns | 0.956–1.464 |
Richer | 1.360 |
1.038–1.783 |
Richest | 2.741 |
1.729–4.347 |
|
||
Nuclear® | 1.000 | |
Joint | 0.922ns | 0.783–1.086 |
|
||
Birth order 1® | 1.000 | |
Birth order-2/3 and interval < = 24 | 0.680 |
0.563–0.821 |
Birth order-2/3 and interval >24 | 0.547 |
0.450–0.664 |
|
||
No® | 1.000 | |
Yes | 1.455 |
1.259–1.681 |
|
||
South® | 1.000 | |
North | 0.219 |
0.165–0.291 |
Central | 0.089 |
0.070–0.113 |
East | 0.157 |
0.127–0.193 |
Northeast | 0.068 |
0.043–0.107 |
West | 0.309 |
0.238–0.400 |
Note: ®: Reference Category.
Level of significance:
p<0.10;
p<0.05;
p<0.01. ns: not significant.
Effect of birth order and interval appeared to be a significant factor affecting postnatal care utilization among adolescent women. Adolescent women with the second or third birth order child utilized less postnatal care than women with the first birth order child. The odds of utilizing postnatal care were found to be low among women with second or third order births with less than < = 24 months of previous birth interval compared to women with first order births (OR = 0.680, CI = 0.563–0.821). Similarly, women with second or third order births of children and with more than 24 months of previous birth interval were also less likely to utilize postnatal care than the first order birth adolescent mothers (OR = 0.547, CI = 0.450–0.664). The odds of utilizing postnatal care were found to be more likely among women who had been recently visited by health workers compared to women who had no contact with any health workers (OR = 1.455, CI = 1.259–1.681). Region of residence again emerged as a strong factor affecting the utilization of postnatal care. Adolescent mothers from the northeast region were found to be the lowest users of postnatal care compared to women from the South region (OR = 0.068, CI = 0.043–0.107).
Ever since the integration of the Safe Motherhood and Child Health Program into the Reproductive and Child Health Program (RCH) in 1996, the Government of India has made several efforts to improve the maternal healthcare utilization. Moreover, because of the low age at marriage pattern and early childbearing trend, utilization of maternal care services among adolescent women has been always a central focus among policy makers. Thus, considering the distinct disadvantage over urban dwellers, the present study assesses the utilization of maternal healthcare services among rural adolescent women who had given birth in the five years preceding the survey. The study has used data from the National Family Health Survey (NFHS) conducted during 2005–06. The objective of the study is to examine the factors that significantly affect the use of maternity care services, namely, full antenatal care, safe delivery and postnatal care among married adolescents in rural India. This study has investigated the factors affecting the use of maternity care services, with the aim of improving the information available to decision-makers who are responsible for planning and administering maternal care programs.
The findings of this study show unacceptably low utilization of maternity care services among adolescent ever married women in rural India. Only about 14%, 46%, and 35% of adolescent women from rural areas received full antenatal care, safe delivery and postnatal care services respectively. A recent cross-sectional survey titled, ‘Youth in India: Situation and Needs Study’ conducted in six states (Andhra Pradesh, Bihar, Jharkhand, Maharashtra, Rajasthan, and Tamil Nadu) of India has revealed that in six selected states, nearly 47% rural married women aged 15–24 utilized safe delivery care, while it was about 78% among urban women
The results from this study show that maternal education exerts a significant influence on the utilization of maternal healthcare services by adolescent women, after controlling for other selected covariates. However, the effect of education is not constant across all educational levels, nor is it the same for the three different types of maternal health services. Many studies conducted in other developing countries have found that maternal education is one of the most important determinants of maternal healthcare utilization, after controlling for other factors
The utilization of safe delivery care was found to be significantly lower among Muslim women than among women belonged to other religions. However, few studies observed mixed effects of religion on maternal care services utilization
In 2005, a committee was appointed by the Prime Minister of India to conduct a systematic study of the social, economic and educational status of the Muslim community. The report of this commission, referred to as the Sachar Report
Although, social group was not a significant factor affecting utilization of full antenatal care, it was a significant predictor for safe delivery and postnatal care utilization among rural adolescent women. Women from Scheduled Castes (SCs), Scheduled Tribes (STs) and Other Backward Classes (OBCs) were less likely to have safe delivery and postnatal care utilization. Despite several affirmative efforts by central and state governments, social group as a significant determinant in health services utilization still persists
The disparity in the use of maternal healthcare utilization across economic groups is also an area of concern among policy makers. Economic status was found to be a significant factor affecting the utilization of maternal healthcare services in India. Adolescent women belonging to the wealthier groups were more likely to use maternal healthcare services than poor adolescent women
Health worker's visits have a significant influence on the utilization of full antenatal care and postnatal care services among rural adolescent women. Other studies in India have also focused on the positive impact of the visit of a health worker, especially during pregnancy, on the utilization of maternal healthcare services
In India, healthcare policy makers frequently discuss regional disparities in the utilization of healthcare services. Results from this study clearly illustrate the importance of region of residence in determining maternal healthcare service utilization among rural adolescent. Results show that compared to the southern region, adolescent women living in rural areas of other regions of the country were found to be significantly less likely to use all three maternal healthcare services. This variation in the utilization of maternal healthcare services across the different regions of India may be linked with the state of socioeconomic and demographic progress. States belonging to the central and eastern regions of India together account for 55% of the total population living below the poverty line
A conditional cash incentive scheme called
To conclude, the present study has documented that the utilization of maternal healthcare services among rural adolescent women is far from acceptable. Low coverage of these services could lead to adverse health outcomes for both the mother and the child. Earlier reproductive health programs in India have paid limited attention to married adolescent girls as a separate category, typically grouping all married women together regardless of current age, age at marriage, and socioeconomic characteristics. The present study emphasizes on specific programs and schemes that acknowledge the need of adolescents and newlywed young mothers living in rural areas in particular. The results of this study have scope for providing the basis for a few policy implications.
First, education was found to have a significant impact on the use of maternal healthcare services. This suggests that improving educational opportunities to adolescent women may have a large impact on the utilization of maternal healthcare services. Promoting higher education for the girl child has been identified as the most effective way to address low coverage of maternal healthcare utilization. In view of this, government policies and programs to improve higher educational opportunities for rural adolescent women need to be reinforced. A recent study indicated that schooling was far from universal among young women in the country; one in four young women had never been to school according to a recently conducted ‘Youth in India: Situations and Needs’ study
There is need for building awareness on the issue of early marriage and adverse effects of early pregnancy at the family and societal levels. Recent studies have emphasized the need to work within existing community structures and attempt to bring awareness to communities about how child marriage compromises opportunities and health for women and their children
In the light of the above discussion, future policies and programs must not only address young people as individuals but consider them in the context of their overall development. In this regard special efforts must be made by the Department of Women and Child Development and Department of Youth to encourage effective participation of young adults in civil society and decision making processes. This study also emphasizes the importance of the recent law enforcement on the Prohibition of Child Marriage Act-2006