Income inequalities in maternal health-care service utilization in India: Applying the Blinder–Oaxaca decomposition method

Maternal health-care service (MHCS) utilization is a crucial indicator of a country’s progress in protecting the health and well-being of its women and children. This paper examines trends, patterns, determinants, and disparities in MHCS utilization between the poorest and richest women in India’s Empowered Action Group. The study used data from the second (1998 – 1999), third (2005 – 2006), fourth (2015 – 2016), and fifth (2019 – 2021) rounds of the National Family Health Survey. A logistic regression model was applied to assess MHCS utilization, and the Blinder–Oaxaca decomposition method (BODM) was used to explain inequalities in utilization between the poorest and richest women. The findings indicate that MHCS utilization has increased over the years among both groups. However, the utilization rate is higher among the poorest women. Furthermore, rural women are less likely to utilize MHCS compared to urban women. Key determinants include women’s education, their partners’ education, mass media exposure (MME), and women’s empowerment. The BODM results show that although MHCS utilization has increased among both groups, inequalities persist, largely explained by coefficient effects. A trend analysis reveals a reduction in discrimination between the poorest and richest women over time. Women’s education, MME, and autonomy are the key factors driving the reduction of inequalities. There is a need for comprehensive strategies to enhance education among disadvantaged women, increase MME, and promote health awareness. The government should empower women through incentives, such as cash benefits, to ensure higher MHCS utilization among poorer women.