Socioeconomic inequalities in maternal health care utilisation in Uttar Pradesh using National Sample Survey data

Maternal healthcare inequalities remain a significant challenge in India, particularly in Uttar Pradesh, where socioeconomic and demographic factors greatly influence access to essential services. Despite initiatives like the National Rural Health Mission (NRHM) and the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH + A) framework, disparities in healthcare utilisation persist. This study examines the variations and socioeconomic inequality in maternal healthcare utilisation, specifically focusing on antenatal care (ANC), institutional delivery, and postnatal care (PNC). The study utilised data from the 71st (2014–15) and 75th (2017–18) rounds of the National Sample Survey (NSS). Descriptive analysis was conducted to examine healthcare utilisation across different socioeconomic groups, including wealth status, education level, caste, and rural-urban residence. Multinomial logistic regression assessed factors influencing the choice between public, private, and no care for ANC, delivery, and PNC services, identifying key predictors and their effects across subgroups. Concentration curves were used to visualise inequality by comparing healthcare utilisation across wealth quintiles with the line of equality. The results reveal significant socioeconomic disparities: wealthier households predominantly use private facilities, while poorer households rely on public services or receive no care. Public facilities show relatively equitable access across wealth groups, particularly in the 75th round, indicating improved reach among disadvantaged populations. However, the persistence of the “No Care” pattern among the poorest households underscores ongoing barriers. Socioeconomic factors, including caste, education, wealth, and regional disparities, play crucial roles, with backward castes, less educated women, and those from weaker regions favouring public healthcare. The study highlights that maternal healthcare utilisation is influenced by socioeconomic determinants, and while greater utilisation of public maternal healthcare services was observed in the later survey round, improvements in public facilities are essential to expand care among higher-income households. Addressing regional disparities and focusing on economically weaker districts will be crucial in reducing maternal healthcare inequalities in Uttar Pradesh.