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46.6 percent pushed into poverty by maternal health spending

Maternal healthcare expenses push 46.6 percent of mothers in India into poverty claims a study by Jawaharlal Nehru University and Indian Institute of Technology, Roorkee. Those most likely to be left in poverty following childbirth are mothers who are illiterate.

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The study incorporates expenses from all stages of pregnancy, including antenatal care, the childbirth itself and the following postnatal care. The expenditure figures were sourced from the National Sample Survey Office.

To establish what was deemed to be “catastrophic expenditure”, the study used World Health Organization (WHO) criteria. The criteria set out that expenditure greater or equal to 40% of a household’s non-subsistence income — the income required to meet basic needs such as food and housing — may be classified as catastrophic expenditure.

As expected the findings of the study illustrate that those from poor backgrounds were disproportionately affected. This backs up other studies into healthcare expenditure in general, which find that huge numbers of people – 63 million people according to another study are left in debt.

Amongst illiterate mothers, the 46.6 percent figure averaging across the population was pushed far higher, with 61 percent left in poverty following childbirth. This is despite the tendency for these women to opt to receive care in government-run hospitals. It suggests  that, despite the typically cheaper costs of public hospitals, the wages of these women are lower so they still spend more than the 40 percent criteria for catastrophic expenditure. Many in India earn less than $2 USD a day, despite government hospitals averaging the cost of childbirth at $28 USD, this is still a large expenditure.

Education was a large factor in avoiding poverty. Only 35.7 percent of those with a graduate degree and above incur enough maternal expenditure to be pushed above the 40% spending threshold, compared to 61 percent of illiterate mothers.

Though there was a reduced chance of being pushed into poverty for educated women, 35.7 percent is still only marginally lower than the 46.6 percent average. With a degree it is expected that these women would be earning more, yet still over a third are pushed into poverty.

It is hoped that government policy will alleviate some of these costs. Over the last few months Prime Minister Narendra Modi has put in place a number of measures that have the potential to bring down healthcare expenditure.

Some recent policies have included the price capping of cardiac stents; the cap on price increases of a number of medical devices; and legislation forcing doctors to allow for the prescription of cheaper generic drugs. However, none of these will directly affect the cost of deliveries.

These policies have damaged relations with a number of Indian pharmaceutical companies, because of this the long term benefits of the policies are under debate. They do however give hope that costs to the patient may be reduced, and so rates of poverty resulting from healthcare expenditure may also be cut down.

Another potential way of lessening the crisis is improving the access of Indian women to family planning services and contraception. This might improve the situation for uneducated and illiterate women, who are more vulnerable to low use of contraceptives and a lack of family planning services. The former increases the risk of unplanned pregnancy, whilst the latter means the woman may not be able to abort her pregnancy – thus potentially leaving them in the position of having to pay their own pregnancy expenses, maybe becoming impoverished as a result.

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