Distress financing in coping with out-of-pocket expenditure for maternity care in India.

BACKGROUND: The cost of maternity care is seen as the barrier in utilizing maternity care, resulting in high maternal deaths. This study focuses on the distress financing and its coping mechanisms associated with maternity care expenditure in India so that corrective measures can be taken to reduce the burden of maternity care. METHODS: This study used the National Sample Survey (NSS) data conducted in 20,014-15 (71st round of NSS) and 2017-18(75th round of NSS). We define distress financing as use of formal borrowing, borrowing from friends or family or sale of asser to finance maternity care. Percentage of pregnant/delivered females using distress financing were calculated.. The present study also used multinomial logistic regression with 95% to understand the impact of socio-economic variables on distress financing and concentration index to measure the inequality in maternity care expenditure. RESULTS: This study found that the maternity care expenditure has decreased from the INR. 9379 in 2014-15 to INR. 7835 in 2017-18. The percentage of households using distress financing is higher among the poorest (13.2%). Almost 14% of the SC households experience distress financing. Among EAG + A states, particularly in Madhya Pradesh and Uttarakhand, the percentage of households are which experience a high level of distress financing increased from 8.9 to 18.3 and 0.7 to 8.1 from 2014-15 to 2017-18 respectively. The study finds that more urban households (37%) utilized insurance than rural households (26%). Among EAG + A states, 67.9 percent of households were dependent upon household savings, and it was 63.6 percent in the non-EAG states. The households with a high burden of maternity care expenditure were at higher risk of borrowing money to finance the cost of maternity as compared to use of savings/income for the same (relative risk (RR) (R: 2.59; P < 0.01; 95% CI: 2.15-3.13). Mothers belonging to the SC caste were at significantly higher risk (RR: 1.43; P < 0.1; 95% CI: 1.07-1.91). of using borrowings as compared to the use of income/savings. Mothers with college education were 50% more likely to use health insurance as compared to those with primary education. CONCLUSIONS: The study found that even though many programs for maternity care services are there, the maternity care expenditure, particularly the delivery care expenses, is very high in many states. The study recommends that India should increase subsidized maternity care facilities to decrease catastrophic maternity expenditure among households.

Progress in child stunting across the world from 1990 to 2015: testing the global convergence hypothesis.

OBJECTIVE: This study has two-fold objectives: first, to test the global convergence hypothesis in the progress of child stunting across 174 countries over the period 1990-2015; second, to identify factors determining the process of convergence or divergence. DESIGN: The study design comprises macro-level cross-country analyses. Our empirical strategy uses parametric convergence models such as absolute and conditional ß-convergence models, while non-parametric convergence models such as Kernel density plots serve as robustness checks. SETTING: The study uses a global setting comprising child stunting information from 174 countries. PARTICIPANTS: The participants for this study are 174 countries. The information on child stunting prevalence for most countries is available from the UNICEF-WHO-WB Joint Child Malnutrition Estimates Expanded Database (April-2019), while national-level surveys are used for those countries where UNICEF-WHO-WB Database is not available. The data for socio-economic variables are taken from the World Bank's data bank (1990-2015). RESULTS: Findings from the absolute ß-convergence model estimates show that progress in child stunting has diverged over the entire period (1990-2015). However, the speed of divergence has reduced for the recent period (2010-2015). The conditional ß-convergence model estimates show that cross-country heterogeneity in GDP per capita, poverty and health care expenditure are significant factors explaining divergence in child stunting. CONCLUSIONS: For replacing current divergence with convergence in child stunting worldwide, the study demonstrates the critical role of economic factors and public spending on health care to reduce child stunting, particularly in countries where progress is slow.