The present research tries to explore unequal access to recommended antenatal care (RANC) among groups and subgroups, especially between poor and non-poor mothers in India. This study used data from the National Family Health Survey 2019–2021. Early initiation for antenatal care (ANC), husband's presence during ANC, pregnancy complications, exposure to mass media, birth interval, and pregnancy wantedness were factors affecting the utilization of RANC. Mothers who were educated, belonged to the Other Backward Classes (OBC) and General social group, were Christian and Sikh, resided in urban areas, were non-poor, and were located in western and southern regions had a significantly higher likelihood of receiving the RANC. The lowest RANC levels were found in the central region, regardless of caste or place of residence. Compared to the other regions, mothers who were poor from the western and southern regions had higher odds of receiving the RANC in their category of poor and even larger odds than women in non-poor categories from various regions. The decomposition analyses revealed that the largest factor explaining the poor and non-poor gaps in utilization of RANC was the region, followed by mothers’ education, mothers’ exposure to mass media, and place of residence.
NayeemJStennettCSharmeenAHossainMMKibriaGM. Rural-urban differences in distributions and determinants of facility delivery among women in Bangladesh. Glob Health J. 2023;7(4):222-229. doi:https://doi.org/10.1016/j.glohj.2023.12.001
2.
BelloCBEsanDTAkereleSAFadareRI. Maternal health literacy, utilisation of maternal healthcare services and pregnancy outcomes among newly delivered mothers: A cross-sectional study in Nigeria. Public Health Pract. 2022;3:100266. doi:https://doi.org/10.1016/j.puhip.2022.100266
3.
KuhntJVollmerS. Antenatal care services and its implications for vital and health outcomes of children: Evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open. 2017;7(11):e017122. doi:https://doi.org/10.1136/bmjopen-2017-017122
4.
DamtieYKefaleBYalewM, et al.The effect of lack of ANC visit and unwanted pregnancy on home child-birth in Ethiopia: A systematic review and meta-analysis. Sci Rep. 2022;12(1):1490. doi:https://doi.org/10.1038/s41598-022-05260-5
United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development.; 2015. Accessed October 11, 2024. https://sdgs.un.org/2030agenda
7.
AliBDhillonPMohantySK. Inequalities in the utilization of maternal health care in the pre- and post-national health mission periods in India. J Biosoc Sci. 2020;52(2):198-212. doi:https://doi.org/10.1017/S0021932019000385
8.
PaulPChouhanP. Socio-demographic factors influencing utilization of maternal health care services in India. Clin Epidemiol Glob Health. 2020;8(3):666-670. doi:https://doi.org/10.1016/j.cegh.2019.12.023
9.
ArsenaultCJordanKLeeD, et al.Equity in antenatal care quality: An analysis of 91 national household surveys. Lancet Glob Health. 2018;6(11):e1186-e1195. doi:https://doi.org/10.1016/S2214-109X(18)30389-9
10.
KumarVSinghP. How far is universal coverage of antenatal care (ANC) in India? An evaluation of coverage and expenditure from a national survey. Clin Epidemiol Glob Health. 2017;5(1):1-7. doi:https://doi.org/10.1016/j.cegh.2016.08.001
11.
DebsarmaDKarmakarRSahaJ. Trends and determinants in the utilization of maternal healthcare services in West Bengal, India: Findings from the 3rd and 4th round national family and health survey. Midwifery. 2022;112:103387. doi:https://doi.org/10.1016/j.midw.2022.103387
12.
JamesKSSinghSKLhungdimH, et al.National Family Health Survey-5: NFHS-5 India Report, Volume I, 2019–21.; 2021.
13.
HoangPANguyenTTHNguyenTHHTranNTMaiTTH. Barriers in providing maternal health care services in a mountainous area. Sex Reprod Healthc.2024;41:100998. doi:https://doi.org/10.1016/j.srhc.2024.100998
14.
MolenaarJBeňováLChristouALangeILvan OlmenJ. Travelling numbers and broken loops: A qualitative systematic review on collecting and reporting maternal and neonatal health data in low-and lower-middle income countries. SSM Popul Health. 2024;26:101668. doi:https://doi.org/10.1016/j.ssmph.2024.101668
15.
Nding’oriDSpitzerRFSongokJ, et al.Improving health equity through sustained academic partnership: Development of a maternal-fetal medicine fellowship training program in western Kenya. AJOG Global Reports. 2024;4(3):100362. doi:https://doi.org/10.1016/j.xagr.2024.100362
16.
NkanguMLittleJKasondeMPongouRDeonandanRYayaS. Mind the data gaps: Comparing the quality of data sources for maternal health services in Cameroon. SSM - Health Systems. 2024;3:100016. doi:https://doi.org/10.1016/j.ssmhs.2024.100016
DasTGuhaP. The puzzle of public health expenditure and healthcare infrastructure in India: An empirical investigation. Region Sci Policy & Pract. 2024;16(2):12710. doi:https://doi.org/10.1111/rsp3.12710
19.
BekyieriyaEIsangSBaguuneB. Mobile health technology in providing maternal health services – awareness and challenges faced by pregnant women in upper west region of Ghana. Public Health in Practice. 2023;6:100407. doi:https://doi.org/10.1016/j.puhip.2023.100407
20.
BilalWQamarKSiddiquiAKumarPEssarMY. Digital health and telemedicine in Pakistan: Improving maternal healthcare. Ann Med Surg. 2022. doi:https://doi.org/10.1016/j.amsu.2022.104425
21.
MishraPSPautunthangNMarbaniangSPAKN. Geographical divide led inequality in accessing maternal healthcare services between hills and valley regions of manipur state, India. Clin Epidemiol Glob Health. 2021;11:100744. doi:https://doi.org/10.1016/j.cegh.2021.100744
22.
AdeyanjuOTubeufSEnsorT. Socio-economic inequalities in access to maternal and child healthcare in Nigeria: Changes over time and decomposition analysis. Health Policy Plan. 2017;32(8):1111-1118. doi:https://doi.org/10.1093/heapol/czx049
23.
AtagubaJENwosuCOObseAG.Is socioeconomic inequality in antenatal care coverage widening or reducing between- and within-socioeconomic groups? A case of 19 countries in sub-saharan Africa. SSM Popul Health. 2023;23:101402. doi:https://doi.org/10.1016/j.ssmph.2023.101402
24.
ObseAGAtagubaJE.Explaining socioeconomic disparities and gaps in the use of antenatal care services in 36 countries in sub-saharan Africa. Health Policy Plan. 2021;36(5):651-661. doi:https://doi.org/10.1093/heapol/czab036
25.
YadavASahniBKumarDBalaKKalotraA.Effect of women’s and partners’ education on maternal health-care services utilization in five empowered action group states of India: An analysis of 13,443 women of reproductive age. Int J Appl Basic Med Res. 2021;11(4):231. doi:https://doi.org/10.4103/ijabmr.ijabmr_121_21
26.
AbubakariAAgbozoFAbiiroGA.Factors associated with optimal antenatal care use in northern region, Ghana. Women Health. 2018;58(8):942-954. doi:https://doi.org/10.1080/03630242.2017.1372842
27.
AliBDebnathPAnwarT.Inequalities in utilisation of maternal health services in urban India: Evidences from national family health survey-4. Clin Epidemiol Glob Health. 2021;10:100672. doi:https://doi.org/10.1016/j.cegh.2020.11.005
28.
KothavaleAMeherT.Level of completion along continuum of care for maternal, newborn and child health services and factors associated with it among women in India: A population-based cross-sectional study. BMC Pregnancy Childbirth. 2021;21(1):731. doi:https://doi.org/10.1186/s12884-021-04198-2
29.
PaudelYRJhaTMehataS.Timing of first antenatal care (ANC) and inequalities in early initiation of ANC in Nepal. Front Public Health. 2017;5:242. doi:https://doi.org/10.3389/fpubh.2017.00242
30.
BankarSGhoshD.Accessing antenatal care (ANC) services during the COVID-19 first wave: Insights into decision-making in rural India. Reprod Health. 2022;19(1):158. doi:https://doi.org/10.1186/s12978-022-01446-2
31.
AlibhaiKMZieglerBRMeddingsLBatungELuginaahI.Factors impacting antenatal care utilization: A systematic review of 37 fragile and conflict-affected situations. Confl Health. 2022;16(1):33. doi:https://doi.org/10.1186/s13031-022-00459-9
32.
World Health Organization. Improving Maternal and Newborn Health and Survival and Reducing Stillbirth: Progress Report 2023.; 2023. Accessed October 11, 2024. https://www.who.int/publications/i/item/9789240073678
33.
AliNSultanaMSheikhN, et al.Predictors of optimal antenatal care service utilization among adolescents and adult women in Bangladesh. Health Serv Res Manag Epidemiol. 2018;5:233339281878172. doi:https://doi.org/10.1177/2333392818781729
34.
SeiduAAOkyereJBuduEDuahHOAhinkorahBO. Inequalities in antenatal care in Ghana, 1998–2014. BMC Pregnancy Childbirth. 2022;22(1):478. doi:https://doi.org/10.1186/s12884-022-04803-y
35.
TamirTTAtallelKA. Spatial variations and determinants of optimal antenatal care service utilisation in Ethiopia: Spatial and survey regression analysis. Public Health. 2023;220:18-26. doi:https://doi.org/10.1016/j.puhe.2023.04.010
36.
KusumaYSKumariARajbangshiP, et al.Maternal healthcare seeking and determinants of adequate antenatal care and institutional childbirth among Indian tribes: A cross-sectional study from nine districts. Eur J Obstetr Gynecol Reproduct Biol. 2024;292:163-174. doi:https://doi.org/10.1016/j.ejogrb.2023.11.026
37.
DakuaMDasKC. The association of household wealth and migration status on antenatal care in India, 2015-16. Clin Epidemiol Glob Health. 2023;22:101309. doi:https://doi.org/10.1016/j.cegh.2023.101309
PathakPKSinghASubramanianSV. Economic inequalities in maternal health care: Prenatal care and skilled birth attendance in India, 1992–2006. PLoS One. 2010;5(10):e13593. doi:https://doi.org/10.1371/journal.pone.0013593
41.
SarohaEAltaracMSibleyLM. Caste and Maternal Health Care Service Use Among Rural Hindu Women in Maitha, Uttar Pradesh, India. J Midwifery Womens Health. 2008;53(5):e41–e47. doi:https://doi.org/10.1016/j.jmwh.2008.05.002
42.
SinghRNeogiSBHazraA, et al.Utilization of maternal health services and its determinants: A cross-sectional study among women in rural uttar pradesh, India. J Health Popul Nutr. 2019;38(1):13. doi:https://doi.org/10.1186/s41043-019-0173-5
43.
DasBHossainMRoyPB. Caste, Social Inequalities and Maternal Healthcare Services in India: Evidence from the National Family and Health Survey. Contemporary Voice of Dalit.2022.Published online October 11, 2022:2455328X2211256. doi:https://doi.org/10.1177/2455328X221125603
44.
MishraPSVeerapandianKChoudharyPK. Impact of socio-economic inequity in access to maternal health benefits in India: Evidence from janani suraksha yojana using NFHS data. PLoS One. 2021;16(3):e0247935. doi:https://doi.org/10.1371/journal.pone.0247935
45.
PakrashiDMaitiSNSahaS. Caste, awareness and inequality in access to maternal and child health programs: Evidence from India. Soc Indic Res. 2022;163(3):1301-1321. doi:https://doi.org/10.1007/s11205-022-02939-0
46.
BangoMGhoshS. Social and regional disparities in utilization of maternal and child healthcare services in India: A study of the post-national health mission period. Front Pediatr. 2022;10:895033. doi:https://doi.org/10.3389/fped.2022.895033
47.
ThakkarNAlamPSaxenaD. Factors associated with underutilization of antenatal care in India: Results from 2019–2021 national family health survey. PLoS One. 2023;18(5):e0285454. doi:https://doi.org/10.1371/journal.pone.0285454
48.
ChattopadhyayAGovilD. Men and maternal health care utilization in India and in selected less-developed states: Evidence from a large-scale survey 2015–16. J Biosoc Sci. 2021;53(5):724-744. doi:https://doi.org/10.1017/S0021932020000498
49.
PaulPL. Male partners’ role in maternal health service utilization: A secondary analysis using 2015-16 national family health survey (NFHS) data. Midwifery. 2022;113:103423. doi:https://doi.org/10.1016/j.midw.2022.103423
50.
ZamaweCBandaMDubeA. The effect of mass media campaign on men’s participation in maternal health: A cross-sectional study in Malawi. Reprod Health. 2015;12(1):31. doi:https://doi.org/10.1186/s12978-015-0020-0
51.
JungariSPaswanB. Supported motherhood? An examination of the cultural context of male participation in maternal health care among tribal communities in India. J Biosoc Sci. 2020;52(3):452-471. doi:https://doi.org/10.1017/S0021932019000580
52.
MoyoEDzinamariraTMoyoPMurewanhemaGRossA. Men’s involvement in maternal health in sub-saharan Africa: A scoping review of enablers and barriers. Midwifery. 2024;133:103993. doi:https://doi.org/10.1016/j.midw.2024.103993
53.
SilvermanJGBoyceSCDehingiaN, et al.Reproductive coercion in uttar pradesh, India: Prevalence and associations with partner violence and reproductive health. SSM Popul Health. 2019;9:100484. doi:https://doi.org/10.1016/j.ssmph.2019.100484
54.
AlanazyWRanceJBrownA. Exploring maternal and health professional beliefs about the factors that affect whether women in Saudi Arabia attend antenatal care clinic appointments. Midwifery. 2019;76:36-44. doi:https://doi.org/10.1016/j.midw.2019.05.012
GashuKDYismawAEGessesseDNYismawYE. Factors associated with women’s exposure to mass media for health care information in Ethiopia. A case-control study. Clin Epidemiol Glob Health. 2021;12:100833. doi:https://doi.org/10.1016/j.cegh.2021.100833
57.
SharmaSAdhikariBPandeyAR, et al.Association between media exposure and maternal health service use in Nepal: A further analysis of Nepal demographic and health survey-2022. PLoS One. 2024;19(3):e0297418. doi:https://doi.org/10.1371/journal.pone.0297418
58.
BiswasRKRahmanNIslamHSenserrickTBhowmikJ. Exposure of mobile phones and mass media in maternal health services use in developing nations: Evidence from urban health survey 2013 of Bangladesh. Contemp South Asia. 2021;29(3):460-473. doi:https://doi.org/10.1080/09584935.2020.1770698
59.
DhawanDPinnamaneniRBekaluMViswanathK. Association between different types of mass media and antenatal care visits in India: A cross-sectional study from the national family health survey (2015–2016). BMJ Open. 2020;10(12):e042839. doi:https://doi.org/10.1136/bmjopen-2020-042839
60.
AdamuA. Exposure of Hausa women to mass media messages: Health and risk perception of cultural practices affecting maternal health in rural communities of Bauchi state, Nigeria. Communication Cultures in Africa. 2020;2(1):6-30. doi:https://doi.org/10.21039/cca.30
61.
AboagyeRGSeiduAAAhinkorahBO, et al.Association between frequency of mass media exposure and maternal health care service utilization among women in sub-saharan Africa: Implications for tailored health communication and education. PLoS One. 2022;17(9):e0275202. doi:https://doi.org/10.1371/journal.pone.0275202
62.
Banke-ThomasABanke-ThomasOKivuvaniMAmehCA. Maternal health services utilisation by Kenyan adolescent mothers: Analysis of the demographic health survey 2014. Sex Reprod Healthc.2017;12:37-46. doi:https://doi.org/10.1016/j.srhc.2017.02.004
63.
DlaminiLPShongweMCSimelaneMSChemhakaGBMagagulaFN. Factors associated with poor maternal health care services utilization in eswatini: A secondary analysis of a nationally representative household survey. Midwifery. 2022;106:103250. doi:https://doi.org/10.1016/j.midw.2022.103250
64.
SalmanuRAOdetolaTD. A community-based intervention study for enhancing hausa women’s knowledge about maternal healthcare services. Int J Afr Nurs Sci. 2024;20:100669. doi:https://doi.org/10.1016/j.ijans.2024.100669
65.
Al-Zubayer MdA, Shanto HH, Kundu S, Sarder MdA, Ahammed B. The level of utilization and associated factors of WHO recommended antenatal care visits in south Asian countries. Dialogues in Health. 2024;4:100175. doi:https://doi.org/10.1016/j.dialog.2024.100175
66.
SiddiqueABPerkinsJMazumderT, et al.Antenatal care in rural Bangladesh: Gaps in adequate coverage and content. PLoS One. 2018;13(11):e0205149. doi:https://doi.org/10.1371/journal.pone.0205149
BacharGAbboudYFaragoN, et al.Interpregnancy interval following missed abortion and the risk for preterm birth. Eur J Obstetr Gynecol Reproduct Biol. 2024;300:202-205. doi:https://doi.org/10.1016/j.ejogrb.2024.07.018
69.
FagbamigbeAFKandalaNBUthmanOA. Mind the gap: What explains the poor-non-poor inequalities in severe wasting among under-five children in low- and middle-income countries? Compositional and structural characteristics. PLoS One. 2020;15(11):e0241416. doi:https://doi.org/10.1371/journal.pone.0241416
70.
GanttAMetzTDKullerJALouisJMCahillAGTurrentineMA. Obstetric care consensus #11, pregnancy at age 35 years or older. Am J Obstet Gynecol. 2023;228(3):B25-B40. doi:https://doi.org/10.1016/j.ajog.2022.07.022
71.
LamminpääRVehviläinen-JulkunenKGisslerMSelanderTHeinonenS. Pregnancy outcomes of overweight and obese women aged 35 years or older – A registry-based study in Finland. Obes Res Clin Pract. 2016;10(2):133-142. doi:https://doi.org/10.1016/j.orcp.2015.05.008
72.
MarquardKWestphalLMMilkiAALathiRB. Etiology of recurrent pregnancy loss in women over the age of 35 years. Fertil Steril. 2010;94(4):1473-1477. doi:https://doi.org/10.1016/j.fertnstert.2009.06.041
73.
FairlieRW. An extension of the blinder-oaxaca decomposition technique to logit and probit models. J Econ Soc Meas. 2005;30(4):305-316. doi:https://doi.org/10.3233/JEM-2005-0259
74.
FairlieRW. The absence of the African-American owned business: An analysis of the dynamics of self-employment. J Labor Econ. 1999;17(1):80-108. doi:https://doi.org/10.1086/209914
75.
SadanaRBlasE. What can public health programs do to improve health equity?Public Health Reports®. 2013;128(6_suppl3):12-20. doi:https://doi.org/10.1177/00333549131286S303
76.
SolarOIrwinA.A Conceptual Framework for Action on the Social Determinants of Health : Social Determinants of Health Discussion Paper 2. World Health Organization; 2013. Accessed October 11, 2024. https://www.who.int/publications/i/item/9789241500852
77.
SannevingLTryggNSaxenaDMavalankarDThomsenS. Inequity in India: The case of maternal and reproductive health. Glob Health Action. 2013;6(1):19145. doi:https://doi.org/10.3402/gha.v6i0.19145
78.
Crear-PerryJCorrea-de-AraujoRLewis JohnsonTMcLemoreMRNeilsonEWallaceM.Social and structural determinants of health inequities in maternal health. J Womens Health. 2021;30(2):230-235. doi:https://doi.org/10.1089/jwh.2020.8882
79.
HamalMDielemanMDe BrouwereVdeCBuningT. Social determinants of maternal health: A scoping review of factors influencing maternal mortality and maternal health service use in India. Public Health Rev. 2020;41(1):13. doi:https://doi.org/10.1186/s40985-020-00125-6
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
