Socioeconomic Inequalities in Out-of-Pocket Expenditure on Antenatal and Postnatal Care in India: A National Cross-Sectional Study
DOI:
https://doi.org/10.55489/njcm.170720266748Keywords:
Maternal Healthcare Services, Health Expenditures, Socioeconomic Factors, Health Equity, Out-of-Pocket Expenditure, IndiaAbstract
Background: Socioeconomic determinants significantly influence maternal healthcare spending in India. Differences in Out-of-Pocket Expenditures (OOPE) for Antenatal care (ANC) and Postnatal care (PNC) pose challenges in achieving equitable maternal healthcare. The objective was to examine socioeconomic inequality in ANC and PNC expenditures in India.
Methods: This study used cross-sectional secondary data from the 75th round of the National Sample Survey (NSS) during 2017-18. The sample included 31,422 women (ANC) and 25,971 women (PNC). Inequality was measured using the Percentile, Gini coefficient, Atkinson index, Generalised Entropy Index (2), and Concentration Index (CI). A survey-weighted Generalised Linear Model (GLM) identified key socioeconomic factors of inequality.
Results: Gini coefficients indicated high inequality (ANC: 0.661; PNC: 0.647) with CIs confirming pro-rich inequality (ANC: CI = 0.154; PNC: CI = 0.117; p < 0.001). GLM results showed general caste women had higher OOPE than Scheduled Tribes (STs) (ANC: IRR = 1.950; PNC: IRR = 1.764). The richest quintile spent more than the poorest (ANC: IRR = 1.320; PNC: IRR = 1.341). Other factors included education, urban residency, southern region, and divergent insurance effects. Uninsured women had lower OOPE for ANC (IRR = 0.853) but higher for PNC (IRR = 1.148).
Conclusions: OOPE for ANC and PNC shows significant socioeconomic inequalities with pro-rich distribution. Divergent insurance effects highlight coverage gaps, warranting redesigned insurance schemes and equity-oriented financial protection for rural, poor, STs, and underserved regions.
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