Assessment of utilisation of government programmes and services by pregnant women in India.

BACKGROUND: Since the implementation of various maternal health programs, Maternal Mortality Ratio (MMR) has significantly declined in India through improvements in maternal health services. However, inequality persists at the regional and socio-economic levels. In light of this, the present study aims to assess the existing regional disparities in utilising various government initiatives for safe motherhood in India. METHODS: National-level datasets such as National Family and Health Surveys (NFHS-3 (2005-06); NFHS-4 (2015-16) and NFHS-5(2019-21); Health Management Information System (HMIS), 2019-20; Sample Registrar System (SRS), 2001-2018) were used in the study. In addition, composite Index and inequality measures (Range, Ratio, and Gini) were calculated to examine inequality. At the same time, the Pearson correlation was used to investigate the correlation between various components of maternal health services and Maternal Mortality Rate (MMR). RESULTS: The composite index score (0.65) reflects that India is still far behind the targets of the utilisation of maternal health care services. Within the utilisation of services, the Gini coefficient reveals that the least inequality was recorded in skilled birth assistance deliveries (0.03) and institutional deliveries (0.04). In contrast, the highest inequality was recorded in receiving Iron and Folic Acid (IFA) Tablets for 100 days (0.19) and four Antenatal Care (ANC) visits (0.13) among selected states. Based on the composite score for maternal health utilisation, Kerala, Tamil Nadu, Andhra Pradesh, Odisha, and Delhi were amongst the best performers, whereas Bihar, Jharkhand, Uttar Pradesh, and Assam were amongst the worst performers. CONCLUSION: This indicates that the government's single-minded focus on enhancing institutional deliveries and skilled health-assisted deliveries has detracted from other essential interventions related to maternal health. Therefore, the states with the utilisation of maternal services need to initiate immediate action to increase the ANC and Post-natal Care (PNC utilisation with more attention towards better implementation of existing ANC programmes by the government.

Forced Out-Migration from Hill Regions and Return Migration During the Pandemic: Evidence from Uttarakhand.

This paper deals with out-migration which has been a common phenomenon in the hill regions and is closely related to their socio-economic and cultural patterns. In particular, male-specific out-migration has been a sustained tradition from the hill districts of Uttarakhand. The people have been migrating not just for seeking diverse avenues of employment, but also for accessing better educational and health opportunities. As per 2011 Census, the overall population growth rate in the state was 1.7% with huge differentials in the hill and plain districts. Hill districts witnessed one-fourth growth (0.7%) of the population compared to that of plain districts (2.8%) suggestive of huge out-migration from these (hill) districts of the state. The important thing to note is that the nature and patterns of out-migration have now paved the way from long-term to permanent out-migration. Also, the lack of employment opportunities is creating distress out-migration to destinations within or outside the state, which has become a major cause of concern. The COVID-19 pandemic has impacted the most short-term migrants who returned to their villages in desperation resulting in despondency and distress. In this context, the paper explores the factors of distress migration by analysing the data from a quick survey of 323 return migrants carried out in June 2020 to understand their employment and livelihood profile, reasons for their return to native places, coping mechanism and future plans. The findings reveal that due to lack of livelihood opportunities in their place of origin, most of them would eventually like to return to their destination places in the future to eke out their living. From a policy point of view, enhancing the economic base and livelihood opportunities by focusing on niche activities with improved provisioning of educational and health infrastructure and services can eventually help restrict out-migration from Uttarakhand.