Inequalities in Maternal Healthcare Utilization in Three Selected Districts of Assam: Insights from Decomposition Analysis

Improving maternal healthcare remains a major public health challenge in developing countries like India, particularly in Assam, which registers the highest maternal mortality ratio among its states. This study is an attempt to investigate the disparities in maternal health care (MHC) utilization across three selected districts and identify contributing factors. Both the concentration index and concentration curve were used to examine the socioeconomic disparities in MHC utilization and examined the factor contribution to these disparities by using Wagstaff’s decomposition analysis method. The findings reveal significant socio-economic disparities in selected indicators of MHC, exhibiting negative CI values. This indicates a concentration of underutilization among economically disadvantaged women, with varying CI levels across the indicators: -0.30459033 for <4 ANC visits, -0.46659631 for underutilization of safe delivery care, and -0.33191864 for no postnatal care within 48 hours of delivery. Decomposition analysis indicates various socioeconomic factors contributing to MHC inequalities. Poor household wealth status emerges as a significant contributor, followed by factors such as the husband’s not involvement in maternity care, women’s illiteracy, and rural residence. Notably, <4 ANC visits play a crucial role in both underutilization of safe delivery care, and non-receipt of postnatal care within 48 hours of delivery. These findings underscore the importance of addressing disparities in MHC utilization to ensure equitable access to services for all women, regardless of their socioeconomic status. Such insights are important for policymakers and healthcare providers in formulating policies to improve maternal health outcomes.