Decomposing the Socio-economic Inequalities in Utilization of Full Antenatal Care in Jharkhand State, India

It is widely evidenced that low socio-economic status is significantly associated with poor health, but inequalities caused by social and economic factors are poorly quantified. This paper attempts to measure contributions of selected factors to the differences in full antenatal care (ANC) utilization in the state of Jharkhand, India, based on the third wave of District Level Household and Facility Survey (DLHS-3) data in 2007–2008. Full ANC is defined as having a minimum of three antenatal visits, at least two tetanus toxoid injections and receiving folic acid tablets for at least 90 days or more during the last pregnancy. Multivariate and decomposition statistical techniques were employed to examine the factors associated with utilization of ANC services and their contributions to inequalities in utilization. Results show that the factors with the largest contribution to utilization of ANC services were poor economic status of women (37.53%), mass media exposure (30.71%), and residence in a rural area (15.56%). The relative contributions of region, mothers’ education, age, and birth order of the women in generating inequalities were small. Therefore, to improve maternal health and to reduce socio-economic gaps in the state, more focus is needed on vulnerable sections of society and regions where the effects of government health programs hardly reach.