A Multilevel Approach to Compare the Relative Effect of Education and Economic Resources on Full Ante Natal Care Services in India

Background: One of the mandates of Millennium Development Goal was a sharp reduction in maternal mortality through improving maternal health care services across developing countries. Estimates of World Health Organization... [ view full abstract ]

Background: One of the mandates of Millennium Development Goal was a sharp reduction in maternal mortality through improving maternal health care services across developing countries. Estimates of World Health Organization suggested that about 286110 women died every year due to pregnancy related complications in developing countries. However, India alone accounts of 57222 deaths of expected mothers each year from preventable causes such as hemorrhage, eclampsia, sepsis and anemia.

Methods: Using a cross sectional data of third round of District level household survey (2007-08) and Multilevel logistic regression analysis, this paper examined the relative effect of human resources and economic resources on the utilization of full antenatal care services in India, by measuring the impact of mother’s education and household wealth at individual, community and district levels.

Results: The result of second order predictive quasi likelihood (PQL2) model showed that significant amount of variation was observed across communities and districts in use of full health care services. Further result showed that simultaneous adjustment of education and wealth had reduced the effect of both at each level compare to only education adjusted and only wealth adjusted model. Compared to the model including only education effects, adjustment for economic resources had reduced the effect of mother’s education at all levels. In contrast, adjusting for education reduces the effect of household relative wealth to a greater extent at each higher wealth quintile, resulting in flattening of the household wealth effect on the likelihood of the maternal health services.

Conclusion: This accumulated research has led to the firm conclusion that the overall level of mother’s education compare to economic status is more important determinant of utilization of maternal health care services in India.