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Do Socioeconomic Inequalities Lead to Deceptive Measurement of Obstetric Morbidity in India?
Authors: Kshipra Jain, Mayank Prakash
Source: El Mednifico Journal, Vol. 2, No. 2
Topic(s): Inequality
Maternal mortality
Country: Asia
Published: APR 2014
Abstract: Background: The extent of maternal mortality is an indicator of disparity and inequity in access to appropriate health care and nutrition services throughout a lifetime, and particularly during pregnancy and childbirth. According to WHO (2005), 99% of maternal deaths occur in developing countries. Three quarters of maternal mortalities result from the direct obstetric complications. However, the ambiguity and variability in existing literature on the magnitude of socio-economic inequality in obstetric morbidity is leading to complexity for priority setting in health policy. The present study aims at assessing how far self-reported obstetric morbidity misleads measurement of socio-economic inequalities in India and to assess whether refined inequality measures can help to overcome this problem. Methods: The study has used data from the most recent round of National Family Health Survey (NFHS-3). We have used concentration indices to access the socio-economic inequalities in self-reported obstetric morbidity and later implied regression based decomposition analysis to find out the contributions of socio-economic predictor. Results: Findings reveal that self-reporting obstetric morbidity survey data is potentially misleading in measuring socio-economic differentials with simple bivariate analysis as greater number of obstetric complications persists in socio-economically advantaged groups which may be not true in reality. However, application of sophisticated regression based decomposition analysis demonstrates that, to some extent, we can overcome the problem of measuring socio-economic inequality, as decomposition analysis shows incidence of obstetric complication are greater among disadvantaged groups. Conclusion: Primarily, the inequalities arise from poverty, education and residing in rural areas. However, the contribution of education to the incidence of obstetric morbidity is negative. This could be because of differences in the educational level of women that potentially affects their awareness and understanding about obstetric complications. The findings thus suggest that education is a key determinant of bias in self-reporting obstetric morbidity. Finally, we conclude that logical explanations of the results are needed when we infer these results for health policy interventions, as decomposition analysis has also failed to overcome the problem of self-reporting morbidities among illiterate women. Keywords Obstetric Morbidity; Socio-economic Inequalities; India