Differentials in Maternal and Child Health Care in Tamil Nadu

The present paper examines the rural urban differentials and the factors influencing net change in maternal and child healthcare (MCH) indicators during the National Family Health Survey NFHS (2015-16) and NFHS-3 (2005-06). The National Family Health Survey (NFHS) collected data from 28,820 ever-married women in the age group of 15 and 5,317 men age 15-54 (NFHS-4) and 5,919 women age 15-49 and 5,696 men age 15-54 (NFHS this paper analyses these data. This paper describes about the trends in MCH indicators by residence, early childhood mortality rates, immunization and anemic status of women and children by usin bivariate analysis and chi square test. The analysis reveals that there is a progress in MCH indicators and also there exist negative performance of certain indicators. Overall, there exits rural urban differentials in MCH achievements though government introduced many government health programs like National Rural Health Mission (NRHM), NUHM and NHM etc., The government have to take steps to reduce rural urban differentials in achieving MCH goals and to reduce early childhood mortality rates.


Introduction
Government of India has introduced various health programs to improve the maternal and child health care. Family planning and family welfare programmes are modified into maternal and child health (MCH), Reproductive and Child Health (RCH) programmes to @ IJTSRD | Available Online @ www.ijtsrd.com | Volume -2 | Issue -3 | Mar-Apr 2018 The present paper examines the rural urban differentials and the factors influencing net change in healthcare (MCH) indicators during the National Family Health Survey NFHS-4 06). The National Family Health Survey (NFHS) collected data from married women in the age group of 15-49 d 5,919 women 54 (NFHS-3) and this paper analyses these data. This paper describes about the trends in MCH indicators by residence, early childhood mortality rates, immunization and anemic status of women and children by using bivariate analysis and chi square test. The analysis reveals that there is a progress in MCH indicators and also there exist negative performance of certain indicators. Overall, there exits rural urban differentials in MCH achievements though government have introduced many government health programs like National Rural Health Mission (NRHM), NUHM and NHM etc., The government have to take steps to reduce rural urban differentials in achieving MCH goals and to reduce early childhood mortality rates.
MCH care, Immunization, Anaemia, Government of India has introduced various health programs to improve the maternal and child health care. Family planning and family welfare programmes are modified into maternal and child health (MCH), Reproductive and Child Health (RCH) programmes to improve the health of mother and children especially in rural areas. National Rural Health Mission (NRHM) has been implemented during 2005 reduce MMR, IMR and to achieve various health goals in rural areas and further expanded to urban as NUHM. Caldwell and Cleland stated that the health status of children is significantly associated with maternal health of women (Caldwell, 1979; Cleland Van Ginneken, 1988). The child survival rate is mainly influenced by child immunization and utilization of MCH care which mainly depends on socio economic characteristics of women (UNICEF, 1990;Kim-Farley et al, 1992;Grant, 1993). People in rural areas are lagging behind people in urban areas in achieving maternal and child health care. The main aim of this paper is to find out the rural urban differentials of maternal and child health care indicators in Tamil Nadu using the findings of National Family Health Surveys conducted during 2005-06 (NFHS 3) and 2015-16 (NFHS 4).

Methodology:
The main objective of this paper is to examine the rural urban differentials in maternal and child health care utilization, outcome and factors influencing the net change. The data for this study have been collected from the large scales surveys namely National Family Health Survey NFHS and NFHS-3 (2005-06) in which information from 28,820 ever-married women in the age group of 15 and 5,317 men age 15-54 (NFHS age 15-49 and 5,696 men age 15 collected in Tamil Nadu. The data was analysed using bivariate analysis and Chi square test to know the significant association between independent and dependent variables. The maternal health variables used in this paper are antenatal care (AN Care), delivery, post natal care (PN Care), BMI, anemia, decision making, spousal violence of women and the child health variables used are Immunization, Vit A, ORS, diarrhea, ARI, breastfeeding, anemia, early child hood mortality rates namely, neonatal mortality, post neonatal mortality, infant mortality, child mortality, under five mortality rate and analysed with social and demographic variables.

RESULTS AND DISCUSSION:
Rural urban differentials in utilization of AN care services are presented in Table 1. The percentage of women who received AN care, first trimester registration and PN care within two days decreased over the periods. Percentage of births delivered in public health facilities is higher in rural areas and the percentage of births delivered in private health facilities is higher in urban areas. There exist a net change of rural urban differentials in first trimester registration, institutional and public health delivery. Note: UR= Urban, RU: Rural Table 2 highlighted the rural urban differentials of BMI, anemic status among men and women, women participate in household decisions and women experienced spousal violence. More than fifty percent of pregnant and non pregnant women aged 15-49 years in rural areas were anemic and the proportion is higher than in urban areas. There exists a positive net change of women with BMI below normal and pregnant women who are anemic in urban areas in improved status. Women participate in household decisions increased but more than one third of women ever experienced spousal violence both in rural and urban areas. Percentage of children who had 3 or more AN check ups and first trimester registration is decreased over the periods, which is higher among illiterate women, women belonging to Muslim community, Scheduled caste women, rural women and among women having birth order one compared with their counterparts. There exist positive improvement on immunization status of children which is higher among educated, Hindu women, scheduled caste, urban women and women with 2-3 birth order. AN care and immunization is significantly associated with birth order and significant at 5 % level. Regarding differentials in child health indicators, early mortality rates are higher in rural areas compared with urban areas in Tamil Nadu except post neonatal mortality rate and is presented in Fig 1. There is a positive net change of improvement exists in early childhood mortality rates over the periods from 2005-06 to 2015-16.    Table 3. It is observed that there exist rural urban differentials in receiving Vit A, ORS by children age 9-59 months and percent of children under 6 months exclusively breastfed but there is a positive net change of improvement was observed during the period from 2005-06 to 2015-16. Percent of children under 3 years breastfed within one hour of birth decreased in urban areas and percent of children age 6-8 months receiving solid or semi solid food and breast milk decreased in both rural and urban areas over the periods. Early child hood mortality rates by social and demographic characteristics of women are presented in Table 4.
There exist a positive net change of improvement, the early childhood mortality rates namely neonatal mortality, infant mortality, child mortality and under 5 mortality rates were decreased over the periods from 2005-06 and 2015-16 in Tamil Nadu. According to NFHS 3, Neonatal mortality is significantly associated with residence, education, religion, child sex, birth order and previous birth interval. Infant mortality is significantly associated with education, religion, child sex, birth order and previous birth interval. Child mortality is significantly associated with education, religion, child sex and birth order. Under 5 mortality is significantly associated with education, child sex and birth order (p<0.05). According to NFHS 4, Neonatal mortality is significantly associated with child sex and birth order. Infant mortality is significantly associated with child sex and birth order. Child mortality is significantly associated with education, child sex and birth order. Under 5 mortality is significantly associated with education, religion, birth order and previous birth interval (p<0.05). Early childhood mortality rate is higher among illiterate women compared with literate and women belonging to Scheduled caste. Similarly childhood mortality is higher among women who delivered male child except for child mortality and under5 mortality in which the mortality rate is higher among women who delivered female child. And the early child mortality is higher among higher birth interval during NFHS 4 (2015-16).

CONCLUSION:
The present paper highlighted the trends in MCH indicators by residence, early childhood mortality rates, immunization and anemic status of women and children and reveals that there is a progress in MCH indicators and also there exist negative performance of certain indicators. Overall, there exits rural urban differentials in MCH achievements though government have introduced many government health programs like National Rural Health Mission (NRHM), NUHM and NHM etc., The government have to take steps to reduce rural urban differentials in achieving MCH goals and to reduce early childhood mortality rates by monitoring the government programs, training to the health personnel, IEC activities and awareness creation among women living in rural areas, women belonging to scheduled caste, illiterate women and women having higher birth interval.