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International Journal for Quality in Health Care Advance Access originally published online on November 17, 2007
International Journal for Quality in Health Care 2008 20(1):62-71; doi:10.1093/intqhc/mzm052
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© The Author 2007. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

Differentials in the quality of antenatal care in India

Manju Rani1, Sekhar Bonu2 and Steve Harvey3

1 Western Pacific Regional Office, World Health Organization, Manila, Philippines
2 Asian Development Bank, Manila, Philippines
3 University Research Corporation, Bethesda, Maryland, USA

Objective. To investigate the socio-economic differentials in the quality (clinical and interpersonal) of antenatal care and also the correlation between differentials in the quality and utilization of antenatal care.

Design. The study uses cross-sectional, nationally representative data from National Family Health Survey (1998–99).

Setting. Four south Indian states (Andhra Pradesh, Karnataka, Kerala and Tamil Nadu) and four north Indian states (Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh).

Main outcomes measured. More than four antenatal care visits for utilization, and index of clinical, information and interpersonal quality of care.

Results. Lower than desired quality of antenatal care was observed in both north and south Indian states, though the quality was significantly better in south India compared with north India, especially among the disadvantaged women. Significant socio-economic differentials in the quality of care were evident in both north and south India, but were more glaring in north India. A significantly positive relationship was observed between the quality and utilization of antenatal care in the rural areas from village-level multivariate analysis.

Discussion. Poor quality of antenatal care is likely to reduce its utilization. Policy and program interventions to improve the quality of care of antenatal care, especially for the poor and other disadvantaged population groups, more so in north India, are essential to improve maternal health outcomes. The India's National Rural Health Mission (NRHM), launched in 2005, should lay greater emphasis on improving the quality of antenatal care, among other things, to increase utilization of antenatal care and achieve better maternal health outcomes.

Keywords: India, antenatal care, quality of services, interpersonal care, inequities

Address reprint requests to: Manju Rani, Western Pacific Regional Office, World Health Organization, Manila, Philippines. E-mail: manju_rani{at}yahoo.com

Accepted for publication October 9, 2007.


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