Continuum of care pathway for maternal healthcare in India: analysis of trends, dropouts, and determinants from 2015 to 2021

This study examined the trends of maternal continuum of care (CoC) across antenatal (ANC), intranatal and postnatal care (PNC) using NFHS-4 to NFHS-5 data and analysed the associated factors in its utilisation employing Anderson’s health services utilisation model in Indian context. A total of 190,898 and 176,877 women aged 15–49 years who had a live birth in the 5 years preceding the surveys [NFHS-4 and NFHS-5] were included respectively. Binary logistic regression identified the need, pre-disposing and enabling factors of CoC pathways. The overall progress of CoC completion was 11.3 points from NFHS-4 (38.7%) to NFHS-5 (50.0%). The largest dropout in CoC was observed in ANC followed by PNC. Odds of completing CoC was higher among women aged 25–34 (AOR:1.18; 95% CI: 1.09–1.27), with higher education (AOR:1.74; 95% CI: 1.58–1.92), from urban (AOR:1.09; 95% CI:1.01–1.19), richer household (AOR: 1.42; 95% CI: 1.29–1.56), southern region (AOR: 2.13; 95% CI: 1.89–2.40), exposed to mass media (AOR:1.51; 95% CI: 1.39–1.65), and covered by health insurance (AOR: 1.24; 95% CI: 1.15–1.35). Policy addressing the barriers inhibiting CoC completion especially in ANC and PNC stages are important. Context specific multisectoral approaches involving family, community, and health system may be warranted especially in low-performing states.