Inequalities in Use of Antenatal Care and Its ServiceComponents in India

OBJECTIVES This study was performed to evaluate the use of individual components of antenatal care (ANC) services by pregnant women across India in addition to counting of ANC visits and then analyze differences according to state, socioeconomic condition, and access to health care services. METHODS The study used a nationally representative sample of 36,850 women from the National Family Health Survey (2005-2006) of India. Outcome measurements were medication, number of ANC visits, and components of ANC, including physical examination and measurements, laboratory examination, and advice about pregnancy. Differences in these outcomes according to 29 states, socioeconomic conditions, and access to health care services were examined. Independent associations between outcome measures and social and health care factors were analyzed. RESULTS The percentages of women who used ANC at least once and four times or more were 81.5% (ranges by states: 38.0 -99.9%) and 46.1% (15.2-97.9%), respectively. Among those who used ANC four times or more, 86.4% (54.2-98.9%) received a blood examination, and 85.8% (70.3-96.3%) were advised to deliver in a hospital. Greater wealth (OR=3.38; 95%CI 2.58-4.42) and higher education level (OR=3.19; 95%CI 2.49-4.14) were associated with receiving a blood examination during ANC. Rural residence was negatively associated with using ANC four times or more (OR=0.64; 95%CI 0.59-0.67) and receiving a blood examination (OR=0.67; 95%CI 0.59-0.76). Those who received ANC at community health centers were less likely to receive a blood pressure examination, blood and urine examination, and advice to deliver in a hospital compared with those who received ANC at public hospitals. CONCLUSION This study showed substantial inequalities in use of ANC and service components of ANC received in India across geographic areas, socioeconomic conditions, and levels of access to health care services. In addition to reducing socioeconomic inequalities, it is necessary to provide quality services to those with limited access to health care services.