Caste-based disparities in the utilisation of maternal healthcare services in India: a decomposition analysis

Adequate utilisation of maternal healthcare services (MHS) could enhance safe motherhood and child delivery. However, the coverage of MHS remains meagre in developing countries, particularly India, with a notable disparity among women from scheduled castes (SC) and scheduled tribes (ST). The present study aims to identify the factors contributing to the discrepancies in the utilisation of full antenatal care, safe delivery, and timely postnatal care (within 48 hours of delivery) among SC/ST women and their non-SC/ST counterparts. An adequate sample of 32,216 ever-married women aged 15–49 was obtained from the 75th round of the National Sample Survey (2017–18). Bivariate analysis and the Fairlie decomposition technique were employed to assess the differences in the utilisation of maternal healthcare services among caste groups. The findings reveal remarkable inequality in the utility of MHS among disadvantaged women. Furthermore, it is evident that the selected covariates contribute to 70–80% inequality in access to maternity care services. Of the explained gap, the mother’s level of education, place of residency, wealth status, and availability of water on the premises were the significant predictors of widening the gap in the utilisation of MHS between caste groups. The remaining unexplained percentage (18–30%) may be due to structural factors not included in the study. Policymakers must design appropriate and context-specific interventions to narrow the gap. Additionally, community health workers may organise workshops to raise awareness of the benefits of maternal healthcare services through audio-visual aids.