Utilisation, equity and determinants of full antenatal care in India: analysis from the National Family Health Survey 4

Abstract

Objectives We examined the utilisation, equity and determinants of full antenatal care (ANC), defined as 4 or more antenatal visits, at least one tetanus toxoid (TT) injection and consumption of iron folic acid (IFA) for a minimum of 100 days, in India. Methods We analysed a sample of 190,898 women from India’s National Family Health Survey 4. Concentration curves and concentration index were used to assess equity in full ANC utilisation. Multivariable logistic regression model was used to examine the factors associated with full ANC utilisation. Results In India, 21% of pregnant women utilised full ANC, ranging from 2.3–65.9% across states. Overall, 51.6% had 4 or more ANC visits, 30.8% consumed IFA for atleast 100 days, and 91.1% had one or more doses of tetanus toxoid. Full ANC utilisation was inequitable across place of residence, caste and maternal education. Registration of pregnancy, utilisation of government’s Integrated Child Development Services (ICDS) and health insurance coverage were associated with higher odds of full ANC utilisation. Lower maternal education, lower wealth quintile(s), lack of father’s participation during antenatal visits, higher birth order, teenage and unintended pregnancy were associated with lower odds of full ANC utilisation. Conclusions Full ANC utilisation in India was inadequate and inequitable. Although half of the women did not receive the minimum recommended ANC visits, the utilisation of TT immunisation was almost universal. The positive association of full ANC with ICDS utilisation and child’s father involvement may be leveraged for increasing the uptake of full ANC. Strategies to address the socio-demographic factors associated with low and inequitable utilisation of full ANC are imperative for strengthening India’s maternal health program. Electronic supplementary material The online version of this article (10.1186/s12884-019-2473-6) contains supplementary material, which is available to authorized users.

Associations of intimate partner violence and reproductive coercion with contraceptive use in Uttar Pradesh, India: How associations differ across contraceptive methods

“…Women and girls in India have over 48 million pregnancies per year, around half (48%) of which are reported to be unintended [1]. These unintended pregnancies are associated with reduced maternal healthcare utilization [2][3][4] and consequent poor maternal and child health outcomes [5,6]. Lack of modern contraceptive (including contraceptive pills, intrauterine devices [IUD], injectable contraception, male condoms, subdermal implants, diaphragms, lactational amenorrhea, and emergency contraceptive pills) use is the proximal causal factor behind unintended pregnancies worldwide [7,8].…”

Maternal Health Care Service Utilization Among Young Married Women in India, 1992-2016: Trends and Determinants

“…Several studies in India have been conducted exploring factors associated with the utilization of maternal health care services and reported the signi cant in uence of demographic and socioeconomic characteristics of women on the use [25][26][27][28]. However, no such study has been conducted till date which primarily focuses on the utilization of essential maternal health care services among young married women.…”

Antenatal service utilization among women in South India: a community based cross sectional study

“…19 Kumar G et al, in their review of NFHS-4 also reported lowest ANC utilization among those with no formal education and odds of full ANC decreased with increasing birth order. 20 This study used snowball sampling to select study subjects which may be a limitation of the study as, it may have lead to partipants who have simialr behavious to be selected.…”