Disparities in spatial access to healthcare facilities for pregnant women: a case study of a hilly region in India

The global maternal mortality crisis has been a cause of worry, with almost 800 women dying every day from preventable causes related to pregnancy and childbirth. To improve maternal survival rates, pregnant women must receive timely and appropriate care throughout their pregnancy. In this context, the location of healthcare facilities and the availability of transportation are critical determinants of maternal health outcomes. This study investigates spatial access to pregnancy care in Himachal Pradesh, a state characterized by challenging hilly terrain in India, with a particular emphasis on the role of public healthcare infrastructure and transport availability in shaping access to care for pregnant women, including antenatal, intranatal, and postnatal care. This study used data from the most recent secondary data from the Demographic Health Survey for India (NFHS-5, 2019–21), the Survey of India, and Open Government Data. It applied spatial analysis, including facility density, distance, and travel time, alongside socio-economic factors affecting pregnancy healthcare access. Univariate LISA assessed spatial autocorrelation, while binomial logistic regression and ANOVA examined socio-economic determinants of antenatal, intranatal, postnatal, and pregnancy care. Analyses were conducted in STATA 14 and RStudio 3.34.0. The findings revealed significant disparities in spatial access to pregnancy care, with central and densely populated districts benefiting from better accessibility, while remote areas faced substantial challenges due to a limited road network and public healthcare facility coverage. The study also highlighted the role of socio-economic factors, with disadvantaged groups experiencing poorer access. In conclusion, spatial accessibility remains a key barrier to equitable pregnancy care access in Himachal Pradesh. Policy recommendations focused on enhancing access to maternal healthcare.