Office of Graduate Education, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS One. 2023 May 8;18(5):e0285454. doi: 10.1371/journal.pone.0285454. eCollection 2023.
Despite progress in recent years, full antenatal care utilization in India continues to be relatively low and inequitable, particularly between states and districts. In 2015-2016, for example, only 51% of women aged 15-49 in India attended antenatal care at least four times during pregnancy. Using data from the fifth iteration of India's National Family Health Survey, our study aims to explore factors related to the underutilization of antenatal care in India.
Data from the most recent live birth in the past five years among women aged 15-49 years were included in our analysis (n = 172,702). Our outcome variable was "adequate antenatal care visits", defined as four or more antenatal visits. Utilizing Andersen's behavioral model, 14 factors were identified as possible explanatory variables. We used univariate and multivariate binary logistic regression models to analyze the association between explanatory variables and adequate visits. Associations were considered statistically significant if p<0.05.
Of the 172,702 women in our sample, 40.75% (95% CI: 40.31-41.18%) had an inadequate number of antenatal care visits. In multivariate analysis, women with less formal education, from poorer households and more rural areas had higher odds of inadequate visits. Regionally, women from Northeastern and Central states had higher odds of inadequate antenatal care utilization compared to those from Southern states. Caste, birth order, and pregnancy intention were also among the variables associated with utilization of antenatal care.
Despite improvements in antenatal care utilization, there is cause for concern. Notably, the percentage of Indian women receiving adequate antenatal care visits is still below the global average. Our analysis also reveals a continuity in the groups of women at highest risk for inadequate visits, which may be due to structural drivers of inequality in healthcare access. To improve maternal health and access to antenatal care services, interventions aimed at poverty alleviation, infrastructure development, and education should be pursued.
尽管近年来取得了进展，但印度的全面产前护理利用率仍然相对较低且不公平，特别是在各州和地区之间。例如，2015-2016 年，印度只有 51%的 15-49 岁妇女在怀孕期间至少接受过四次产前护理。利用印度第五次国家家庭健康调查的数据，我们的研究旨在探讨与印度产前护理利用率低相关的因素。
本分析纳入了过去五年中 15-49 岁妇女最近一次活产的数据（n=172702）。我们的结局变量是“充分的产前护理就诊次数”，定义为四次或以上的产前就诊次数。利用安德森行为模型，确定了 14 个可能的解释变量。我们使用单变量和多变量二元逻辑回归模型分析了解释变量与充分就诊次数之间的关联。如果 p<0.05，则认为关联具有统计学意义。
在我们的样本中，有 172702 名妇女中，40.75%（95%CI：40.31-41.18%）接受的产前护理就诊次数不足。在多变量分析中，受教育程度较低、来自贫困家庭和农村地区的妇女接受不足次数的产前护理就诊的可能性更高。在区域层面，与来自南部各州的妇女相比，来自东北部和中部各州的妇女获得充分产前护理的可能性更高。种姓、出生顺序和妊娠意图也是与产前护理利用相关的变量之一。
尽管产前护理利用率有所提高，但仍令人担忧。值得注意的是，接受充分产前护理就诊的印度妇女比例仍低于全球平均水平。我们的分析还揭示了在接受不足次数的产前护理就诊的妇女群体中存在连续性，这可能是由于医疗保健获取方面不平等的结构性驱动因素所致。为了改善母婴健康和获得产前护理服务，应采取旨在减轻贫困、基础设施发展和教育的干预措施。
