Opportunity Cost of Maternal Health Care for the Urban Poor in India: A Missed Opportunity for Cost-Effective Strategies

Opportunity costs of seeking maternal health care comprise the loss of earnings caused by the inability to participate in work for the time spent seeking maternal health care. The objective of this study was to examine the amount of opportunity costs incurred by urban poor women living in an Indian city; the determinants of the opportunity costs in antenatal, delivery, and postnatal phases; and the role of the opportunity costs in the health-care seeking of these women. Information was collected through a quantitative survey using structured questionnaires and from in-depth interviews. Women living in the slums of Kolkata City, who had given birth in the previous year, participated in the survey. The study confirms the presence of opportunity costs in all three phases of maternal health care. The average amounts were $21 for antenatal care, $55 for delivery, and $6.75 for postnatal care. Binary logistic regressions revealed that family type, parity, involvement in decision-making, type of delivery, and complication status were significantly (p < 0.005) associated with the incidence of opportunity costs. Findings from in-depth interviews established the negative role of opportunity costs on maternal health care by urban poor women. The study suggests that preventing the occurrence of opportunity costs and better coping mechanisms are needed to improve the maternal health of urban poor women.