Access to care is a vital but complex element of quality of care since it determines whether a client even gets to the service provider. The available community based evidence suggests that there is considerable variation in the level of outreach visits by the Auxiliary Nurse Midwife (ANM), largely by geographical location, with significantly higher visits in the southern and western than in the north Indian states.
In a four state study conducted over a decade ago, 89% and 93% women surveyed in Tamil Nadu and Karnataka reported having been visited by a female paramedical worker in the last three months, compared with 53% and 61% women from Bihar and West Bengal, respectively. There were also differentials in access to care between urban and rural areas, if utilization of care is taken as a proxy for access to care. The National Family Health Survey-3 (NFHS-3) conducted during 2005-06 reports that only 62.4% of ever married women respondents living in urban areas reported having received the WHO recommended four antenatal visits compared to 27.7% rural women.
The District Level Household Survey-3 (DLHS-3) conducted during 2007– 2008 indicates an overall improvement in access to maternal care (if three or more 11ante-natal checkups are taken as proxy) in the post NRHM period, perhaps more for the high focus states (with poor health indicators) than the non-high focus states (which hitherto had better health indicator).
