| Caste among Hindus in India is a non-modifiable socio-demographic characteristic, often the basis of segregation and discrimination. Despite the provision of subsidized maternal and child healthcare services, utilization in rural Uttar Pradesh (UP), India is poor. Studies showed that upper caste (UC) women were more likely to utilize healthcare services than the lower caste (LC) women but this association is inadequately researched.;We explored whether caste was a determinant of utilization of maternal healthcare (MH) and neonatal healthcare (NH) services among rural Hindu women and neonates in Maitha, UP, India. Data from the ‘Morbidity and Performance Assessment’ study for 482 women who were pregnant during Jan 1998-Jan 1999 and their 464 live born singleton neonates were analyzed. Through multivariable logistic regression analysis we estimated the crude odds ratios of higher utilization of maternal/neonatal healthcare services by UC women/neonates compared to the LC women/neonates. Odds ratios were adjusted for neonate’s gender, maternal age, parity, literacy, number of living sons/brothers, and socio-economic status.;Utilization of all MH and NH services was lower than expected. UC women were twice as likely to utilize antenatal care (ORa=2.39, 95% CI: 1.21, 4.71) and tetanus toxoid (ORa=2.19, 95% CI: 1.28, 3.73) and almost 5 times more likely to be attended by a trained professional at birth (ORa=4.77, 95% CI: 1.81, 12.54) than LC women, after adjusting for the socio-demographic factors. UC women were as likely to utilize iron folic acid, post partum care, contraceptives, and treatment outside home as LC women. NH services utilization such as aseptic cord cut, aseptic cord tie, aseptic cord dressing (at the day of birth and until cord fell off), routine neonatal care, and treatment outside home did not vary by caste. Number of living sons/brothers, socio-economic status, and maternal literacy were other significant determinants.;Caste was a significant determinant of basic MH services utilization even after adjusting for the socio-demographic factors. Health policies and programs can overcome low utilization and caste disparities by encouraging participation of LC groups in healthcare delivery, combining services and making them available through one provider, and by generating awareness about the available services. |
