Level of completion along continuum of care for maternal, newborn and child health services and factors associated with it among women in India: a population-based cross-sectional study

Abstract

Background India, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal mortality could be avoided if the continuum of care (CoC) is provided in a structured pathway from pregnancy to the postpartum period. Therefore, this article attempted to address the following research questions: What is the level of completion along CoC for MNCH services? At which stage of care do women discontinue taking services? and what are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India? Methods The study utilized the data from the National Family Health Survey (NFHS-4) conducted during 2015–16 in India. The analysis was limited to 107,016 women aged 15–49 who had given a live birth in the last 5 years preceding the survey and whose children had completed 1 year. Four sequential fixed effect logit regression models were fitted to identify the predictors of completion of CoC. Results Nearly 39% of women in India had completed CoC for maternal and child health by receiving all four types of service (antenatal care, institutional delivery, post-natal care and full immunization of their child), with substantial regional variation ranging from 12 to 81%. The highest number of dropouts in CoC were observed at the first stage with a loss of nearly 38%. Further, education, wealth index, and health insurance coverage emerged as significant factors associated with CoC completion. Conclusion The major barrier in achieving CoC for maternal and child health is the low utilization of ANC services in the first stage of the continuum and hence should be addressed for increasing CoC completion rate in the country. The gaps across all the levels of CoC indicate a need for increased focus on the CoC approach in India. A strategy should be developed that will connect all the components of MNCH avoiding dropouts and the MNCH provision should be standardized to provide services to every woman and child.

Pooled Prevalence and Determinants of Completion of Maternity Continuum of Care in Sub-Saharan Africa: A Multi-Country Analysis of Recent Demographic and Health Surveys

“…The findings of the current study are lower than the evidence from the previous studies in Motta and Hulet Eji Enese, Ethiopia 47% ( 8 ), Debre Berhan, Ethiopia 37.2% ( 22 ), Enemy District, Northwest Ethiopia 45% ( 15 ), and in India 39% ( 23 ). An explanation for this lower prevalence in the current study might be due to the difference in the composition of the study participants.…”

“…Participants with higher educational status are 3.61 times more likely to complete the maternity continuum of care compared with those who have no formal education. This finding is supported by different studies ( 8 , 22 , 23 ). The possible explanation might be due to an increased level of understanding of medical terms and cooperation with healthcare providers among educated women.…”

Measurement and Mapping of Maternal Health Service Coverage Through a Novel Composite Index: A Sub-National Level Analysis in India

“…South zone, particularly have performed sizable well with respect to institutional deliveries, IFA supplementation, ANC check-ups and screening for HIV. [41][42][43][44]. The states of Kerala, Tamil Nadu, Karnataka and Andhra Pradesh from south zone are the front runners in the overall 'Sustainable Development Goals' (SDGs) with relatively high SDG index scores, which has remarkably in uenced their coverage and receipt of health care services such as institutional care and antenatal care coverage [45].…”

Improving newborn health with family-centered, early postnatal care: a quasi-experimental study

“…Although institutional deliveries have nearly doubled in India over the past decade (9), insufficient follow-up visits create gaps in postnatal care. According to the National Family Health Survey (NFHS-4), only 39% of pregnant women in India had completed CoC between 2015 and 2016, including the utilization of four major aspects: 4 + antenatal care, institutional delivery, postnatal care, and immunization (8). In LMICS, only 58% of babies complete the postnatal visit within two days after birth (10).…”