Intersecting inequities: Gender norms and socioeconomic predictors of antenatal care adequacy: A cross-sectional study

Background: Antenatal care (ANC) encompasses preventive, diagnostic, and educational services to optimize maternal and neonatal outcomes. Although ANC coverage in India has improved, disparities in access and quality remain. While socioeconomic factors influencing ANC are documented, the role of gender norms is less understood. This study investigates the socioeconomic and gender-norm predictors of adequate ANC using nationally representative Indian data. Methods: The analyzed data included 24,371 women aged 15–49 years with a live birth in the 5 years preceding the 2019–2021 National Family Health Survey-5. ANC adequacy was defined as receipt of at least six of eight World Health Organization-aligned components, including skilled provider contact, early registration, and essential clinical and counseling services. Multivariable logistic regression estimated adjusted odds ratios (AORs) for socioeconomic and gender-related predictors, controlling for confounders. Results: Overall, 91.3% of women received adequate ANC. Higher education (AOR: 5.014; 95% confidence interval [CI]: 4.175–6.020), wealth (richest quintile AOR: 5.368; 95% CI: 4.408–6.538), and internet use (AOR: 2.088; 95% CI: 1.875–2.324) were strongly associated with adequacy. Joint healthcare decision-making with a partner (AOR: 1.224; 95% CI: 1.038–1.442) and employment (AOR: 1.273; 95% CI: 1.131–1.432) also increased odds. Unexpectedly, later age at marriage (≥20 years) and sexual debut (≥20 years) were linked to substantially lower odds (AORs: 0.178 and 0.167, respectively; both P < 0.001). Conclusion: ANC adequacy in India is influenced by socioeconomic and gender-norm factors. Enhancing education, reducing economic gaps, improving digital access, and addressing relational and cultural norms are essential for equitable maternal healthcare.