Out-Of-Pocket Expenditure and its Associated Factors among Antenatal and Postnatal Women Attending a Tertiary Care Hospital in Chhattisgarh, India: A Cross-Sectional Study

Introduction: Out-of-pocket expenditure (OOPE) imposes substantial financial burden on households, and despite various maternal and child health (MCH) schemes, OOPE for maternal care remains high in Chhattisgarh. This study aimed to determine the extent of OOPE during the antenatal and postnatal periods among women attending a tertiary care hospital and to identify the socio-demographic and economic factors associated with OOPE. Methods: A hospital-based cross-sectional study was conducted among 220 women (110 antenatal and 110 postnatal) attending a tertiary care hospital between May and October 2025, using convenience sampling. OOPE over the preceding 30 days, and its source of financing was recorded and analysed using appropriate statistical tests. Results: Almost all participants (217 of 220) incurred some OOPE, irrespective of MCH scheme utilization. Savings were the predominant source of financing among utilizers, while borrowing was more common among non-utilizers. Direct costs, particularly transportation and food, formed a major share of postnatal expenditure. Catastrophic OOPE was significantly higher among non-utilizers (OR= 12.67, 95%CI: 5.08, 31.58) and was significantly associated with maternal age above 30 years, nuclear family type and unskilled occupation. Conclusions: Socio-demographic factors are associated with OOPE during maternal care. MCH scheme utilization was associated with lower catastrophic expenditure, but financial protection remains incomplete, particularly during Postnatal period, and gaps in awareness and access persist. Strengthening entitlement-based schemes may help progress towards universal health coverage.