Poorest & uneducated mothers benefit least from healthcare services: Study

While the poorest households had the highest utilisation of ICDS services in 2006, their share became the second lowest in 2016.

Business Standard : Despite a four-fold increase in the number of women and children receiving supplementary nutrition under the Integrated Child Development Services (ICDS) programme in the 10 years to 2016, a large proportion of the poorest have not benefited, a new study has found.

Women who were uneducated or from the poorest households had lower access to the flagship programme the study found. While the poorest households had the highest utilisation of ICDS services in 2006, their share became the second lowest in 2016, the study says, suggesting that the reasons could include poor delivery, difficulty of accessing remote regions, and social divisions such as caste.

Started in 1975, ICDS, the world’s largest scheme of this kind, provides nutrition and health services to all pregnant and lactating mothers and children under six years of age. In addition to take-home food supplements and hot, cooked meals, the programme provides health and nutrition education; health check-ups; immunisation; and pre-school care services at either government-run anganwadi (childcare) centres or at home.

The study, “India’s Integrated Child Development Services programme; equity and extent of coverage in 2006 and 2016”, co-authored by researchers the International Food Policy Research Institute (IFPRI), a research advocacy based in Washington D. C., and the University of Washington, US, will be published in the World Health Organization’s April 2019 bulletin.

Using data from two rounds of the National Family Health Survey conducted in 2005-06 and 2015-16, the researchers examined equity in ICDS’ expansion and the factors that determine the utilisation of its services.

Low to middle socio-economic brackets were more likely to receive food supplements, nutrition counselling, health check-up and child-specific services than both the poorest and the richest groups, the researchers found. Women with no schooling were also less likely to receive ICDS services than those with primary and secondary education.

“Even though overall utilization has improved and reached many marginalised groups such as historically disadvantaged castes and tribes, the poor are still left behind, with lower utilisation and lower expansion throughout the continuum of care,” said IFPRI research fellow and study co-author, Kalyani Raghunathan, in a statement.

Researchers found these gaps especially pronounced in the largest states of Uttar Pradesh and Bihar, which also carry the highest burden of undernutrition. While both states have shown improvements in 2016, they still fall behind national averages, suggesting that overall poor performance in high-poverty states could lead to major exclusions, the authors said.