Maternity care left BPL families poorer in Karnataka: Study

Emphasising the need for better public health infrastructure in Karnataka, a recent study on maternity health services shows that a large section of BPL families incurred "catastrophic expenditures'', spending more than 10% of their annual income to avail healthcare, though they were accessing facilities in government hospitals. 

Unable to bear the expenses, many families were forced to take loans, pledge gold etc to avail maternal healthcare, according to the report.

Conducted by Grassroots Research And Advocacy Movement (GRAAM) and published for the state government, the report was made public recently. It surveyed 2104 BPL families in five districts, including Belagavi, Haveri, Ballari, Chikkamagaluru and Bengaluru Rural, covering beneficiaries of 'Tayi Card' enrolled in 2014-15 and 2015-16. Among those surveyed, 61% of women spent more than 10% of their annual income to avail maternity services. This, in spite of several central and state sponsored schemes, the study stated. 

One of the main reasons for out-of-pocket expenditure (OOPE) was lack of infrastructure in government hospitals. For instance, scanning facilities are not available in taluk hospitals and even in some district hospitals like Chikkamagaluru, owing to lack of radiologists. As a result, families have no choice but to turn to private labs.

Also, the amount given to beneficiaries under government schemes did not cover the maternity costs. The total maternity cost of normal deliveries in public facilities is about Rs 13,000 and that for cesarean deliveries is more than Rs 22,000, it found. 

Another major chunk of expense was identified as "informal payments", given to healthcare staff. Transport (especially in remote areas) was an added burden as women had to travel to taluk or district headquarters for some services. There were indirect costs too, such as family members losing their daily wages if they had to escort a pregnant woman to checkups. 

Ananya Samajdar, Head of Research, GRAAM, pointed out that unhindered access to institutional deliveries in public facilities was critical for further reduction of infant and maternal mortality rates. "High OOPEs create barriers in such access and may lead to further impoverishment of poor families through catastrophic expenditure," she said. 

Separate allocation for travel and food, strengthening primary and community health centres, appointing more staff, better ambulance services for delivery care and introduction of mobile ultra-sonographic vehicles are among the recommendations made in the report. That apart, it has also suggested appointment of Upa Lokayukta at the district-level to increase accountability in healthcare services.