The World Health Organization recommends at least eight antenatal care contacts (ANC8+) to reduce maternal and neonatal risks. Despite improvements in maternal health, significant socioeconomic, caste-based, and geographic disparities persist in India, particularly among disadvantaged populations. Understanding long-term trends and the drivers of inequality guides targeted interventions. This study examines trends in ANC8+ utilisation, identifies key determinants, and analyses changes in socioeconomic, caste, and rural–urban inequalities in India between 1998 and 2021. Data from four rounds of the National Family Health Survey (NFHS, 1998–99, 2005–06, 2015–16, and 2019–21) were used. A logistic regression model was employed to identify the determinants of ANC8+ visits. Besides, socioeconomic and caste-based inequalities were assessed using the Blinder–Oaxaca decomposition method, comparing the rural vs. urban, richest vs. poorest wealth quintiles, and ST/SC vs. non-ST/SC groups. ANC8+ utilisation increased steadily over the 24 years, with poorer states showing notable gains. Rural–urban disparities declined over time, although rural women continued to experience lower coverage. Women’s education, autonomy, wealth, parity, age, and mass media exposure were significant predictors of ANC8+ utilisation. Decomposition results indicate persistent wealth-based inequalities, primarily driven by differences in education, income, and access to information. In contrast, caste-based disparities narrowed, reflecting improvements among socially marginalised groups. Although ANC8+ utilization has improved nationwide, substantial socioeconomic and geographic inequalities still persist. Strengthening women’s education, financial protection, awareness, and rural health infrastructure is essential for achieving equitable maternal healthcare and accelerating progress towards the Sustainable Development Goals in India.
Yadav et al. (Thu,) studied this question.