The utilisation of Reproductive, Maternal, Newborn and Child Health (RMNCH) services remains lower among the Scheduled Tribes (ST) in India than the rest of the country’s population. The tribal population's poorest and least-educated households are further denied access to RMNCH care as a result of the intersection of their social status, wealth, and education levels. The study analyses the wealth- and education-related inequalities in the utilisation of RMNCH services within the ST population in Odisha and Jharkhand.
In this study, we aim to determine trends in wealth- and education-related inequalities in Reproductive Maternal Neonatal and Child Health (RMNCH) services utilisation among tribal women in the states of Odisha and Jharkhand using NFHS-3 (2005-06), NFHS-4 (2015-16), NFHS-5 (2019-21). We have constructed two summary measures of RMNCH services utilisation, namely the Co-coverage indicator and a modified Composite Coverage Index (CCI), to determine wealth- and education-related inequalities in the utilisation of RMNCH indicators within the ST population in Odisha and Jharkhand. The absolute and relative inequalities with respect to wealth and education within the ST population are estimated by employing the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). The results of the study highlight that access to RMNCH services is easier for women who are better educated and belong to wealthier households. The SII and RII values in the co-coverage indicator and modified CCI exhibit an increase in wealth-related inequalities in Odisha between NFHS-4 (2015-16) and NFHS-5 (2019-21). Whereas, in Jharkhand, the wealth- and education-related absolute and relative inequalities in both indices present a reduction between 2005 and 2021. Among the indicators, utilisation of vaccination was high, while the uptake of Antenatal Care Centre Visits and Vitamin A supplementation remained low in 2019-21. The study results underscore the urgency of targeted policies and interventions to address the inequalities in accessing RMNCH services among ST communities. The observed inequalities with respect to education point to the need to improve formal education among tribal populations, specifically among women, so as to positively impact access to health services in the long term. In the short term, policies could focus on the low number of ANC visits among tribal women, particularly in Jharkhand. A multi-dimensional approach that considers the socioeconomic, cultural and geographical factors affecting healthcare should be adopted while formulating health policies to reduce the inequalities in access to healthcare.