Women’s empowerment and maternal healthcare continuity in India: a latent variable analysis

Background Continuity of maternal healthcare (CMHC) is essential for improving maternal and neonatal health outcomes; however, the independent contribution of women’s empowerment to CMHC utilization in India remains inadequately understood. This study examined the association between women’s empowerment and CMHC utilization among Indian women. Methods Data from 176,877 women aged 15–49 years who had a recent live birth were obtained from the National Family Health Survey (NFHS-5, 2019–2021). Women’s empowerment was measured as a latent construct using Generalized Structural Equation Modeling (GSEM). CMHC utilization was categorized as poor, moderate, or complete. Survey-weighted ordered logistic regression and average marginal effects were used to identify factors associated with CMHC utilization. Results Overall, 11.1% of women had poor, 67.0% had moderate, and 21.9% achieved complete CMHC utilization. Higher educational attainment (AOR = 2.20, 95% CI: 2.06–2.34), household wealth (AOR = 2.86, 95% CI: 2.68–3.06), older maternal age, and lower birth order were significantly associated with better CMHC utilization, whereas rural residence was negatively associated. The latent women’s empowerment score was not independently associated with CMHC utilization after adjustment ( p = 0.179). Conclusion Socioeconomic inequalities remain the primary determinants of continuity of maternal healthcare in India. Policies that promote female education, reduce economic disparities, strengthen rural maternal health services, and improve equitable access to quality maternal healthcare are essential to enhance continuity of care and accelerate progress toward the Sustainable Development Goals.