Coverage of continuum of Maternal, Newborn and Child Health (MNCH) care in a nationally representative sample of 40,687 mother–child dyads of India: a report from NFHS-5

A package of Maternal, Newborn and Child Health (MNCH) services are administered sequentially to mother-child dyads as Continuum of Care (CoC), but often each intervention is reviewed in silo in low-middle-income countries like India. Therefore, we aimed to examine the coverage of the entire package by computing composite CoC score of Indian mother-child dyads. We also aimed to estimate the effect of Indian states on CoC after adjusting for variations in socio-economic determinants; and then rank the Indian states based on their adjusted effects. Women (15-49 years) with most recently-born child (in last 5 years) aged 12-23 months (n = 40,687) from National Family Health Survey-5 (2019-21) of India were analysed. Nineteen CoC interventions (Y/N) were added (equally-weighted) to construct a composite CoC score. Multi-level models were used to study the state effect on CoC score after adjusting for individual-level wealth, education, caste, urban/rural residence and fertility. Indian states were ranked by their CoC performance using adjusted state residuals from the model. Only 3% dyads received all the 19 interventions, however, 50% received 14/19. Sterile delivery kit usage (94.4%), newborn weighing (92.4%) and skilled birth attendance (89.4%) were services with higher coverage, whereas early initiation of breastfeeding (43.7%) and appropriate iron-folate consumption (56.8%) had low coverage. The state factor explained 23% CoC score. Odisha, a comparatively less-developed state, was ranked first and also other less-developed states like Madhya Pradesh and Chhattisgarh outperformed richer counterparts. But many traditionally weaker Northern and North-Eastern states continued to lag behind. Odisha and a few other less-developed Indian states demonstrated that good CoC coverage can be achieved even with restricted resources, perhaps through strengthening of public health system. Other states should emulate and help India as a nation achieve full CoC coverage of all its mother-child dyads and attain MNCH-related sustainable development goals.