Conclusionĭistress financing on institutional delivery was higher among the less educated, poor and in private health centers. The probability of incurring distress financing was higher for mothers who had caesarean birth, delivered in private health centers and incurred high OOPE on institutional delivery. The predicted probability of incurring distress financing was 0.31 among mothers belonging to the poorest wealth quintile compared to 0.09 in the richest quintile, and 0.40 for those who incurred OOPE of more than INR 20,000. Finding are robust across the states of India. Savings was more prevalent among mothers compared to those who met the OOPE by borrowing/selling of assets. The extent of distress financing on institutional delivery was high in poorer state of Bihar and Odisha and in the state of Telangana that had highest prevalence of caesarean delivery. One in four mothers resorted to borrowing or selling to meet the OOPE on institutional delivery. The OOPE on institutional delivery has strong economic and educational gradient. Composite variables, descriptive analyses, concentration index (CI), concentration curve (CC) and predicted probability were used to estimate the extent of distress financing for institutional delivery in India. Distress financing was defined as borrowing money or selling assets to meet the OOPE on delivery care. Dataĭata from the fourth round of National Family Health Survey (NFHS 4), 2015–16 was used for the analysis. Though many studies have examined the OOPE and CHS, few studies have examined the nature and extent of distress financing on institutional delivery in India. Despite large investment in central and state sponsored schemes for maternal care, out-of-pocket expenditure (OOPE) and catastrophic health spending (CHS) on institutional delivery remain high over time, across states and across socio-economic groups.
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