Inequity in access to health services between migrants and natives of Chandigarh, India

People often migrate from rural to urban areas within a country or from less developed to more developed countries for better life opportunities but may remain outside the range of health services. The purpose of this paper was to find out the socio-economic and health system factors that may affect the utilization of health services by the migrants.

Five villages and three slums were randomly selected from 23 villages and 18 slums of Chandigarh, a northwest Indian city. Using stratified random sampling, 145 migrants and 63 native women, who were pregnant or had delivered a baby from April 1, 2009 to March 31, 2012 were interviewed using semi-structured interview schedule. χ2 was used for testing statistical significance of the differences, and logistic regression was utilized to evaluate the “independent effect” of migration on Maternal and Child Health (MCH) service utilization.

The level of education was higher among migrants than the natives but their income was less than that of natives. Majority of the migrant women had registered themselves for antenatal care (ANC) in the first trimester of pregnancy (55 percent) compared to the natives (21 percent), but only few had availed more than three ANC check-ups (18 percent) as compared to the natives (44 percent). Knowledge about danger signs of childhood diarrhea and pneumonia was low among migrants compared to the natives (p < 0.0001). Health workers interacted less often with migrants (29 percent) than the natives (67 percent). After controlling the effect of socio-economic and -demographic variables, utilization of MCH care services were significantly higher among natives than the migrants. Inadequate community support among migrants led to the lower utilization of MCH care.

Present study reflects early ANC registration among migrants but the number of ANC visits much less than the natives. This could be further be investigated using qualitative methods.

Specific strategies are required to address the health needs of migrants such as formation of community-based support groups. Health services and health workers need to be oriented to support migrants to the special needs of migrants.

Reduction in inequality in accessing health between natives and migrants can be addressed with social support.

The study supports the fact that migration is one of the social determinants of health. Lack of community support to migrants is the major barrier in accessing the health services.