title: Inequalities in advice provided by public health workers to women during antenatal sessions in rural India.
abstract: OBJECTIVE
  Studies have widely documented the socioeconomic inequalities in maternal and child health related outcomes in developing countries including India. However, there is limited research on the inequalities in advice provided by public health workers on maternal and child health during antenatal visits. This paper investigates the inequalities in advice provided by public health workers to women during antenatal visits in rural India.
  
  
  RESULTS
  The District Level Household Survey (2007-08) was used to compute rich-poor ratios and concentration indices. Binary logistic regressions were used to investigate inequalities in advice provided by public health workers. The dependent variables comprised the advice provided on seven essential components of maternal and child health care. A significant proportion of pregnant women who attended at least four ANC sessions were not advised on these components during their antenatal sessions. Only 51%-72% of the pregnant women were advised on at least one of the components. Moreover, socioeconomic inequalities in providing advice were significant and the provision of advice concentrated disproportionately among the rich. Inequalities were highest in the case of advice on family planning methods. Advice on breastfeeding was least unequal. Public health workers working in lower level health facilities were significantly less likely than their counterparts in the higher level health facilities to provide specific advice.
  
  
  CONCLUSIONS
  A significant proportion of women were not advised on recommended components of maternal and child health in rural India. Moreover, there were enormous socioeconomic inequalities. The findings of this study raise questions about the capacity of the public health care system in providing equitable services in India. The Government of India must focus on training and capacity building of the public health workers in communication skills so that they can deliver appropriate and recommended advice to all clients, irrespective of their socioeconomic status.
authors.affiliation: Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India. abhi_iips@yahoo.co.in
authors.forename: Abhishek
authors.initials: A
authors.lastname: Singh
authors.forename: Saseendran
authors.initials: S
authors.lastname: Pallikadavath
authors.forename: Faujdar
authors.initials: F
authors.lastname: Ram
authors.forename: Reuben
authors.initials: R
authors.lastname: Ogollah
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002669:Child Welfare; D003150:Community Health Workers; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India; D008429:Maternal Welfare; D008875:Middle Aged; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011634:Public Health; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult