Out-of-pocket Expenditure and Maternal Healthcare access in India

This paper examines how out-of-pocket expenditure (OOPE) on maternal healthcare is associated with access to antenatal care, institutional delivery, and postnatal care in India, and assesses the extent of district-level variation in both expenditure and access. Drawing on secondary data from the National Family Health Survey-5 (NFHS-5, 2019–21), the National Sample Survey 75th Round on Social Consumption: Health (2017–18), and the Health Management Information System (HMIS), the paper synthesises existing evidence on financial barriers to maternal care and the socioeconomic and health-system factors associated with district-level disparities. The paper further evaluates the effectiveness of three major government schemes like the Janani Suraksha Yojana (JSY), the Janani Shishu Suraksha Karyakram (JSSK), and the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) in reducing financial barriers to maternal healthcare access. Findings indicate that while institutional delivery rates have improved nationally, OOPE persists in both public and private facilities and varies substantially across districts, with poorer and structurally underserved districts bearing a disproportionate burden. The paper concludes with policy recommendations focused on strengthening financial protection mechanisms and addressing supply-side gaps in underserved districts.