Effectiveness of Multiple-Strategy Community Intervention in Reducing Geographical, Socioeconomic and Gender Based Inequalities in Maternal and Child Health Outcomes in Haryana, India

PLoS One. 2016 Mar 22;11(3):e0150537. doi: 10.1371/journal.pone.0150537. eCollection 2016.


Objective: The implemented multiple-strategy community intervention National Rural Health Mission (NRHM) between 2005 and 2012 aimed to reduce maternal and child health (MCH) inequalities across geographical, socioeconomic and gender categories in India. The objective of this study is to quantify the extent of reduction in these inequalities pre- and post-NRHM in Haryana, North India.

Methods: Data of district-level household surveys (DLHS) held before (2002-04), during (2007-08), and after (2012-13) the implementation of NRHM has been used. Geographical, socioeconomic and gender inequalities in maternal and child health were assessed by estimating the absolute differences in MCH indicators between urban and rural areas, between the most advantaged and least advantaged socioeconomic groups and between male and female children. Logistic regression analyses were done to observe significant differences in these inequalities between 2005 and 2012.

Results: There were significant improvements in all MCH indicators (p<0.05). The geographical and socioeconomic differences between urban and rural areas, and between rich and poor were significantly (p<0.05) reduced for pregnant women who had an institutional delivery (geographical difference declining from 22% to 7.6%; socioeconomic from 48.2% to 13%), post-natal care within 2 weeks of delivery (2.8% to 1.5%; 30.3% to 7%); and for children with full vaccination (10% to 3.5%, 48.3% to 14%) and who received oral rehydration solution (ORS) for diarrhea (11% to -2.2%; 41% to 5%). Inequalities between male and female children were significantly (p<0.05) reversed for full immunization (5.7% to -0.6%) and BCG immunization (1.9 to -0.9 points), and a significant (p<0.05) decrease was observed for oral polio vaccine (4.0% to 0%) and measles vaccine (4.2% to 0.1%).

Conclusions: The implemented multiple-strategy community intervention National Rural Health Mission (NRHM) between 2005 and 2012 might have resulted in significant reductions in geographical, socioeconomic and gender inequalities in MCH in Haryana, as causal relationships cannot be established with descriptive research.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child Health / statistics & numerical data*
  • Family
  • Female
  • Gender Identity
  • Geography / statistics & numerical data
  • Humans
  • Immunization / statistics & numerical data
  • India
  • Infant
  • Male
  • Measles Vaccine / immunology
  • Middle Aged
  • Poliovirus Vaccine, Oral / immunology
  • Residence Characteristics / statistics & numerical data*
  • Rural Population / statistics & numerical data*
  • Socioeconomic Factors
  • Vaccination / statistics & numerical data


  • Measles Vaccine
  • Poliovirus Vaccine, Oral

Grants and funding

The study was funded by the National Rural Health Mission, Haryana. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.