Trends, economic inequalities and predicted probabilities in maternal health care services in India, 2005–2021

Maternal mortality has decreased over past decades, but utilization of maternal health care services among some socioeconomic sections of society remains a persistent concern; hence, it’s the focus of the study. The objective is to observe the trends, economic inequalities, and predicted probabilities in utilization of prenatal care (PNC) and skilled birth attendance (SBA) among mothers in India and some selected states (Uttar Pradesh, West Bengal, Maharashtra, and Andhra Pradesh) and the place of child delivery. Analysis was done using the data of three rounds of NFHS, i.e., NFHS-3 to NFHS-5 (2005–2021), in India. Mothers aged 15–49 years were considered for the analysis. For trends in utilization of PNC and SBA, bivariate analysis has been conducted. Economic inequalities were viewed using the Wagstaff concentration index and concentration curve. Binary logistic and multinomial logistic regressions were performed for predicted probabilities of utilization of PNC and SBA and for place of delivery. Utilization of PNC and SBA among mothers increased from 35% to 58% and from 35% to 72% in India during 2005–2021. Among lower and higher-wealth group mothers, PNC utilization increased from 22% to 52% and from 63% to 70%, respectively, in India. SBA utilization among lower and higher-wealth-group mothers during study period in India increased from 22% to 67% and from 62% to 81%, respectively. All considered states showed major increments in utilization of these services. Pro-rich inequalities were obtained among mothers in the utilization of PNC and SBA in India and selected states. Predicted probabilities of using PNC and SBA were lower in lower-wealth-group as compared to higher-wealth-group mothers, and predictive probabilities of child delivery at public and private health facilities were more in lower and higher-wealth-group mothers, respectively, in India during 2005–2021. PNC and SBA indicate increasing utilization trends among lower and higher-wealth-group mothers in selected states and in India, respectively. Pro-rich inequality means lower wealth group mothers utilized less PNC and SBA as compared to higher wealth group mothers in India and the states observed. In the case of place of delivery, lower-wealth group mothers delivered children mostly at public health facilities, whereas higher-wealth group mothers delivered at private health facilities.