Predictors of maternal healthcare utilization among poor rural women:Comparison of two Indian states

Although India has implemented national/state strategies to improve maternal health, the country continues to be highest contributor to worldwide maternal deaths. In 2005, the Indian government introduced Janani Suraksha Yojana (JSY), a conditional cash transfer scheme, to incentivize women to deliver in health facilities. Although cash is a major incentive, multiple other factors are also likely to influence women's decision-making about maternal health service utilization. Our study investigates and compares the role of socio-demographic and health system predictors in influencing utilization of maternal health care among poor rural women in Tamil Nadu and Gujarat states. District Level Household Survey 3 data (women and village/ward questionnaires) were utilized with a sample of 2267 women to examine predictors of four outcomes: adequate antenatal care, institutional deliveries, private facility deliveries, and Cesarean sections. Predictors included maternal and paternal education, parity, female autonomy, availability of primary health center, availability of all-weather road to facility, and receipt of JSY payment.

Results revealed that socio-demographic factors and health system factors are important predictors of maternal health care utilization, with some similarities and some differences in state findings. JSY payment predicted use of institutional and private facilities, as well as C-Section in Tamil Nadu, but not antenatal care. Transportation to a health facility also predicted institutional deliveries in both states. Differential findings are placed in context by examining state policies and health infrastructures. Findings underscore the importance of customizing maternal health policies to address state needs, and continuing evaluation of JSY's impact on poor rural women.