Bridging the Gap: Examining the level, trends and determinants of Adequacy of Quality Antenatal Care in India

Abstract

Background Antenatal care (ANC) is an important component of the continuum of care for a mother’s health as it is a complete package of not only timely diagnosis of obstetric conditions but it also awares women about the sign of complications due to pregnancy and the importance of family planning and breastfeeding. It has been estimated that by increasing coverage as well as the quality of ANC nearly all maternal deaths are preventable in low- and middle-income countries. However, there have been very few studies with regard to quality antenatal care in India. Therefore, this study attempts to assess the adequacy of quality ANC in India. Objectives Firstly, it attempts to understand the trends and patterns in components of quality ANC and secondly it analyses the determinants of quality ANC in India. Data & Methods: This study is based on data from National Family Health Survey. The dependent variable is the quality of antenatal care composed of skilled health care, timeliness, sufficiency, and appropriateness in content. Both bivariate and multivariate generalised ordered logit regression analysis has been employed. Results The findings indicate that in 2015-16, there were 16% of births without antenatal care, which decreased to just 6% in 2019-21. Despite significant improvement, the components of antenatal care are far from the requirement of Sustainable Development Goals (SDG). The overall quality of antenatal care is just 33% in NFHS-5, rising 10 percentage points from NFHS-4. Southern state has highest utilisation of adequate quality of ANC. The utilisation of adequate quality of ANC increases with women’s education, wealth quintile and decreases with birth order. It is higher in urban areas; those covered by health insurance and have mass media exposure. Conclusion Despite some improvements in coverage of antenatal care, the quality of antenatal care is very low in the country and requires urgent attention by policy and program makers.