Utilization of integrated child development services in India: programmatic insights from national family health survey, 2016

The Integrated Child Development Services (ICDS) program launched in
India in 1975 is one of the world’s largest flagship programs that aims to
improve early childhood care and development via a range of healthcare,
nutrition and early education services. The key to success of ICDS is in finding
solutions to the historical challenges of geographic and socioeconomic
inequalities in access to various services under this umbrella scheme. Using
birth history data from the National Family Health Survey (Demographic and
Health Survey), 2015-2016, this study presents (a) socioeconomic patterning
in service uptake across rural and urban India, and (b) continuum in service
utilization at three points (i.e., by mothers during pregnancy, by mothers
while breastfeeding and by children aged 0-72 months) in India. We used
an intersectional approach and ran a series multilevel logistic regression
(random effects) models to understand patterning in utilization among
mothers across socioeconomic groups. We also computed the area under
the receiver operating characteristic curve (ROC-AUC) based on a logistic
regression model to examine concordance between service utilization across
three different points. The service utilization (any service) by mothers during
pregnancy was about 20 percentage points higher for rural areas (60.5
percent; 95% CI: 60.3; 30.7) than urban areas (38.8 percent; 95% CI: 38.4;
39.1). We also found a lower uptake of services related to health and nutrition
education during pregnancy (41.9 percent in rural) and early childcare
(preschool) (42.4 percent). One in every two mother-child pairs did not avail
any benefits from ICDS in urban areas. Estimates from random effects model
revealed higher odds of utilization among schedule caste mothers from
middle-class households in rural households. AUC estimates suggested a
high concordance between service utilization by mothers and their children
(AUC: 0.79 in rural; 0.84 in urban) implying a higher likelihood of continuum if
service utilization commences at pregnancy.