Maternal and neonatal health expenditure in mumbai slums (India): A cross sectional study
Jolene Skordis-Worrall,Noemi Pace,Ujwala Bapat,Sushmita Das,Neena Shah More,Wasundhara Joshi,Anni-Maria Pulkki-Brännström,David Osrin +7 more
TLDR
High expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context and differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance Spending highlight the heavier burden borne by the most poor.Abstract:
Background: The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty. Methods: We used expenditure data for maternal and neonatal care, collected during post-partum interviews. Interviews were conducted in 2005-2006, with a sample of 1200 slum residents in Mumbai (India). We analysed expenditure by socio-economic status (SES), calculating a Kakwani Index for a range of spending categories. We also calculated catastrophic health spending both with and without adjustment for coping strategies. This identified the level of catastrophic payments incurred by a household and the prevalence of catastrophic payments in this population. The analysis also gave an understanding of the protection from medical poverty afforded by coping strategies (for example saving and borrowing). Results: A high proportion of respondents spent catastrophically on care. Lower SES was associated with a higher proportion of informal payments. Indirect health expenditure was found to be (weakly) regressive as the poorest were more likely to use wage income to meet health expenses, while the less poor were more likely to use savings. Overall, the incidence of catastrophic maternity expenditure was 41%, or 15% when controlling for coping strategies. We found no significant difference in the incidence of catastrophic spending across wealth quintiles, nor could we conclude that total expenditure is regressive. Conclusions: High expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective is to increase institutional deliveries without forcing households deeper into poverty, these inequities will need to be addressed. Reducing out-of-pocket payments and better regulating informal payments should have direct benefits for the most poor. Alternatively, targeted schemes aimed at assisting the most poor in coping with maternal spending (including indirect spending) could reduce the household impact of high costs.read more
Citations
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Inequity in India: the case of maternal and reproductive health
TL;DR: Economic status, gender, education, social status (registered caste or tribe), and age (adolescents) are found to be closely interrelated when influencing use of and access to maternal and reproductive health care in India.
Journal ArticleDOI
Out-of-pocket expenditure on institutional delivery in India
TL;DR: The objective of this paper is to understand the regional pattern and socio-economic differentials in out-of-pocket (OOP) expenditure on institutional delivery by source of provider in India and recommend that facilities in public health centres of poorly performing states are improved and public-private partnership models are developed to reduce the economic burden for households of maternal care.
Journal ArticleDOI
Community Mobilization in Mumbai Slums to Improve Perinatal Care and Outcomes: A Cluster Randomized Controlled Trial
Neena Shah More,Ujwala Bapat,Sushmita Das,Glyn Alcock,Sarita Patil,Maya Porel,Leena Vaidya,Armida Fernandez,Wasundhara Joshi,David Osrin +9 more
TL;DR: Findings from a cluster-randomized trial conducted in Mumbai slums aimed to evaluate whether facilitator-supported women's groups could improve perinatal outcomes are reported.
Journal ArticleDOI
Barriers to emergency obstetric care services in perinatal deaths in rural gambia: a qualitative in-depth interview study.
TL;DR: Delays in accessing EmOC are critical in perinatal deaths, and timely availability of emergency transport services and prompt decision-making are warranted for improved perinnatal outcomes in rural Gambia.
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Lectures on public economics
TL;DR: The Lectures on Public Economics (LPE) as mentioned in this paper is the best advanced-level textbook on public finance and has been widely used in the field of economics. But it is not suitable for the general public.
Journal ArticleDOI
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