title: Inequity in India: the case of maternal and reproductive health.
abstract: BACKGROUND
  Millennium Development Goal (MDG) 5 is focused on reducing maternal mortality and achieving universal access to reproductive health care. India has made extensive efforts to achieve MDG 5 and in some regions much progress has been achieved. Progress has been uneven and inequitable however, and many women still lack access to maternal and reproductive health care.
  
  
  OBJECTIVE
  In this review, a framework developed by the Commission on Social Determinants of Health (CSDH) is used to categorize and explain determinants of inequity in maternal and reproductive health in India.
  
  
  METHODS
  A review of peer-reviewed, published literature was conducted using the electronic databases PubMed and Popline. The search was performed using a carefully developed list of search terms designed to capture published papers from India on: 1) maternal and reproductive health, and 2) equity, including disadvantaged populations. A matrix was developed to sort the relevant information, which was extracted and categorized based on the CSDH framework. In this way, the main sources of inequity in maternal and reproductive health in India and their inter-relationships were determined.
  
  
  RESULTS
  Five main structural determinants emerged from the analysis as important in understanding equity in India: economic status, gender, education, social status (registered caste or tribe), and age (adolescents). These five determinants were found to be closely interrelated, a feature which was reflected in the literature.
  
  
  CONCLUSIONS
  In India, economic status, gender, and social status are all closely interrelated when influencing use of and access to maternal and reproductive health care. Appropriate attention should be given to how these social determinants interplay in generating and sustaining inequity when designing policies and programs to reach equitable progress toward improved maternal and reproductive health.
authors.affiliation: Department of Public Health, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden. linda.sanneving@ki.se
authors.forename: Linda
authors.initials: L
authors.lastname: Sanneving
authors.forename: Nadja
authors.initials: N
authors.lastname: Trygg
authors.forename: Deepak
authors.initials: D
authors.lastname: Saxena
authors.forename: Dileep
authors.initials: D
authors.lastname: Mavalankar
authors.forename: Sarah
authors.initials: S
authors.lastname: Thomsen
mesh_terms: D000367:Age Factors; D005260:Female; D014943:Global Health; D054624:Health Status Disparities; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: India; disadvantaged populations; inequity; maternal and reproductive health; millennium development goal 5; social determinants of health
references.citation: Reprod Health Matters. 2000 Nov;8(16):83-91
references.pmid: 11424254
references.citation: J Biosoc Sci. 2012 Jan;44(1):1-26
references.pmid: 21933465
references.citation: J Health Popul Nutr. 2011 Jun;29(3):245-54
references.pmid: 21766560
references.citation: Int Perspect Sex Reprod Health. 2010 Jun;36(2):62-71
references.pmid: 20663742
references.citation: Reprod Health Matters. 2007 Nov;15(30):91-102
references.pmid: 17938074
references.citation: Health Policy Plan. 2009 Nov;24(6):445-56
references.pmid: 19687135
references.citation: BMC Public Health. 2011 Mar 08;11:150
references.pmid: 21385404
references.citation: Natl Med J India. 2007 Nov-Dec;20(6):294-6
references.pmid: 18335795
references.citation: Lancet. 2010 Jun 5;375(9730):2009-23
references.pmid: 20569841
references.citation: Int J Qual Health Care. 2008 Feb;20(1):62-71
references.pmid: 18024998
references.citation: Reprod Health Matters. 2010 May;18(35):163-74
references.pmid: 20541095
references.citation: J Fam Plann Reprod Health Care. 2011 Jul;37(3):136-45
references.pmid: 21628349
references.citation: Int J Gynaecol Obstet. 2010 Jun;109(3):245-6
references.pmid: 20207357
references.citation: PLoS One. 2012;7(2):e31666
references.pmid: 22355386
references.citation: Reprod Health Matters. 2004 May;12(23):88-99
references.pmid: 15242214
references.citation: J Biosoc Sci. 2001 Jul;33(3):339-59
references.pmid: 11446398
references.citation: Matern Child Health J. 2011 Nov;15(8):1381-8
references.pmid: 20859759
references.citation: Lancet. 2011 Feb 5;377(9764):505-15
references.pmid: 21227492
references.citation: J Midwifery Womens Health. 2008 Sep-Oct;53(5):e41-7
references.pmid: 18761290
references.citation: BMC Pregnancy Childbirth. 2010 Jul 30;10:38
references.pmid: 20670456
references.citation: BMC Pregnancy Childbirth. 2010 Jun 06;10:30
references.pmid: 20525393
references.citation: Violence Against Women. 2008 Oct;14(10):1181-98
references.pmid: 18802213
references.citation: J Urban Health. 2010 Mar;87(2):254-263
references.pmid: 20108049
references.citation: J Biosoc Sci. 2009 May;41(3):329-53
references.pmid: 19036173
references.citation: Arch Gynecol Obstet. 2008 Oct;278(4):329-32
references.pmid: 18274767
references.citation: J Health Popul Nutr. 2009 Apr;27(2):293-302
references.pmid: 19489422
references.citation: BMC Pregnancy Childbirth. 2011 Apr 17;11:30
references.pmid: 21496315
references.citation: J Health Popul Nutr. 2008 Jun;26(2):241-50
references.pmid: 18686557
references.citation: PLoS Med. 2011 Nov;8(11):e1001115
references.pmid: 22069378
references.citation: Int J Health Serv. 2007;37(3):537-54
references.pmid: 17844933
references.citation: Int J Equity Health. 2011 Dec 05;10:59
references.pmid: 22142036
references.citation: J Sex Med. 2011 Feb;8(2):376-82
references.pmid: 20946154
references.citation: J Med Ethics. 2001 Aug;27(4):275-83
references.pmid: 11479360
references.citation: Trop Doct. 2010 Apr;40(2):85-6
references.pmid: 20305100
references.citation: Stud Fam Plann. 2008 Sep;39(3):177-86
references.pmid: 18853639
references.citation: Health Place. 2001 Sep;7(3):197-208
references.pmid: 11439255
references.citation: Indian J Med Res. 2007 Oct;126(4):355-63
references.pmid: 18032810
references.citation: Int J Health Serv. 2001;31(3):469-74
references.pmid: 11561999
references.citation: J Health Popul Nutr. 2009 Jun;27(3):368-78
references.pmid: 19507752
references.citation: Lancet. 2009 May 30;373(9678):1883-9
references.pmid: 19278721
references.citation: J Urban Health. 2010 Mar;87(2):264-277
references.pmid: 20148311
references.citation: Reprod Health Matters. 2010 May;18(35):154-62
references.pmid: 20541094
references.citation: Arch Gynecol Obstet. 2010 Sep;282(3):245-54
references.pmid: 19727783
references.citation: Soc Sci Med. 2009 Sep;69(6):926-33
references.pmid: 19656604
references.citation: Soc Sci Med. 2012 Jun;74(11):1802-11
references.pmid: 21741737
references.citation: Int J Equity Health. 2011 Jan 07;10:1
references.pmid: 21214941
references.citation: Int Perspect Sex Reprod Health. 2010 Sep;36(3):132-9
references.pmid: 20880798
references.citation: Natl Med J India. 2010 Jul-Aug;23(4):198-200
references.pmid: 21192511
references.citation: Soc Sci Med. 2010 Nov;71(10):1711-8
references.pmid: 20561728
references.citation: J Urban Health. 2011 Apr;88(2):311-28
references.pmid: 21331748
references.citation: J Obstet Gynaecol. 2010 Feb;30(2):132-6
references.pmid: 20143970
references.citation: Public Health Nutr. 2011 Feb;14(2):365-72
references.pmid: 20939942
references.citation: J Obstet Gynaecol Res. 2008 Apr;34(2):238-41
references.pmid: 18412788
references.citation: Bull World Health Organ. 2007 Oct;85(10):812-9
references.pmid: 18038064
references.citation: J Urban Health. 2008 Mar;85(2):291-9
references.pmid: 18197478
references.citation: PLoS One. 2010 Oct 27;5(10):e13593
references.pmid: 21048964
references.citation: BMC Public Health. 2008 Jan 24;8:29
references.pmid: 18218093
references.citation: J Urban Health. 2012 Aug;89(4):639-58
references.pmid: 22399250
references.citation: J Biosoc Sci. 2012 Jan;44(1):57-71
references.pmid: 21933466
references.citation: Womens Health Issues. 2010 Jan-Feb;20(1):80-5
references.pmid: 20123178
references.citation: Stud Fam Plann. 2010 Dec;41(4):263-76
references.pmid: 21465727
references.citation: Trop Doct. 2007 Apr;37(2):85-8
references.pmid: 17540086
references.citation: Matern Child Health J. 2011 Aug;15(6):700-12
references.pmid: 20680670
references.citation: J Health Popul Nutr. 2010 Oct;28(5):494-500
references.pmid: 20941901
references.citation: J Health Popul Nutr. 2010 Aug;28(4):383-91
references.pmid: 20824982
references.citation: J Biosoc Sci. 2009 May;41(3):381-98
references.pmid: 18845026