Maternal Health Service Utilization in India: A Study of Barriers, Disparities, and Health Outcomes

Abstract Background Neonatal and infant mortality remains a critical public health concern in India, despite targeted health interventions. NFHS-5 showed around 59% of women had attended 4 or more antenatal care visits, underscoring service utilization gaps. This study examines variation in full ANC utilization and institutional delivery in India. The research is crucial as it investigates barriers in service utilization, and its impact on neonatal and infant mortality. Methods The study utilized National Family Health Surveys (NFHS 4 & 5) data, focusing on women aged 15-49 with a live birth in last 5 years. Spatial analysis was performed to assess disparities, with logistic regression identifying determinants influencing service use. Impact on health outcomes analyzed through binary logistic. Results Full ANC coverage increased from 21% to 32%, and institutional births increased from 79% to 89% between NFHS- 4 and NFHS-5, though rural uptake remained lower. Barriers included distance (ANC: OR = 0.90; Delivery: OR = 0.81), permission (ANC: OR = 0.73), and autonomy constraints. Education, wealth, and media exposure positively influenced service use (p < 0.01). Results showed a significant negative association of ANC care & institutional births with health outcome in India. Women receiving full ANC care had 35% lower odds of neonatal mortality (AOR: 0.65; 95% CI: 0.60-0.72) and 33% of infant mortality (AOR: 0.67; CI: 0.62-0.72). Institutional births resulted in 24% reduction in the odds of neonatal mortality and infant mortality by 29%. Conclusions Maternal health service coverage has improved, yet regional disparities persist, mainly in Northern India. Barriers like distance to facilities, medical care permission, and autonomy hinder service utilization. Enhancing women's education, wealth, media exposure, and engagement with health workers boosts service use and promote equity. Strengthening maternal service usage is crucial for reducing neonatal & infant mortality in India. Key messages • Improving access, autonomy, education, media exposure, and last-trimester frontline worker interaction strengthens maternal service coverage. • Increased maternal service utilization contributes to reduced neonatal and infant mortality.