State-Level and Regional Variation in Maternal Healthcare Utilization in India: An Ecological Analysis of NFHS-6 (2023–24)
DOI:
https://doi.org/10.51957/Healthline_857_2026Keywords:
Maternal healthcare utilization, NFHS-6, Ecological study, India, Antenatal careAbstract
Background: Maternal healthcare utilization is a key determinant of maternal and child health outcomes. Despite substantial improvements in maternal health indicators in India, disparities persist across States and Union Territories (UTs).The study aimed to assess State-Level and Regional Variation in Maternal Healthcare Utilization in India.Materials and Methods: An ecological study was conducted using National Family Health Survey-6 (NFHS-6) data.Four maternal healthcare indicators: first trimester antenatal care (ANC) registration, four or more ANC visits, institutional delivery, and iron and folic acid (IFA) consumption for at least 180 days during pregnancy were used to calculate Composite Maternal Healthcare Score.Women's internet use was considered as the explanatory variable. Pearson correlation, simple linear regression, one-way ANOVA, and post-hoc analyses were performed. States and UTs were categorized into quartiles based on women's internet.Results:Considerable inter-state variation in maternal healthcare utilization was observed. Kerala achieved the highest Composite Maternal Healthcare Score (89.38), while substantial disparities were noted across regions. Southern (81.60 ± 7.18) and Western (80.89 ± 3.47) regions demonstrated significantly higher scores than other regions (p=0.001).Linear regression indicated that internet use explained 9.2% of the variation in maternal healthcare utilization (R²=0.092). States in the highest internet-use quartile had significantly higher maternal healthcare scores than those in the lowest quartile (p=0.002).Conclusion: Significant geographical disparities in maternal healthcare utilization persist across India.Policies aimed at reducing regional inequities and improving digital inclusion among women may contribute to enhanced maternal healthcare utilization.
References
1. World Health Organization. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group
and UNDESA/Population Division. Geneva:WHO;2023.
2. Patton GC, Viner RM, Linh le C, Ameratunga S, Fatusi AO, Ferguson BJ, et al. Mapping a global agenda for adolescent health. J
Adolesc Health. 2010;47:427–32. doi: 10.1016/j.jadohealth. 2010.08.019. DOI: https://doi.org/10.1088/1475-7516/2010/08/019
3. Ponna SN, Upadrasta VP, Babu Geddam JJ, Dudala SR, Sadasivuni R, Bathina H. Regional variation in utilization of Antenatal care
services in the state of Andhra Pradesh. J Family Med Prim Care. 2017 Apr-Jun;6(2):231-239. doi: 10.4103/2249-4863.220024. DOI: https://doi.org/10.4103/2249-4863.220024
PMID: 29302523; PMCID: PMC5749062.
3. World Health Organization. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group
and UNDESA/Population Division. Geneva:WHO;2023.
4. World Health Organization. Maternal health [Internet]. Geneva: WHO; 2024 [cited 2026 Jun 3]. Available from:https://www.who.int/health-topics/maternal-health
5. Rejoice PR, Ravi ShankarAK. Differentials in maternal health care service utilization: Comparative study between Tamil Nadu and
Karnataka.WorldAppl Sci J. 2011;14:1661–9. [Google Scholar]
6. Bartlett LA, Mawji S, Whitehead S, Crouse C, Dalil S, Ionete D, et al. Where giving birth is a forecast of death: Maternal mortality in
four districts of Afghanistan, 1999-2002. Lancet. 2005;365:864–70. doi: 5.1016/S0140-6736(05)71044-8. DOI: https://doi.org/10.1016/S0140-6736(05)71044-8
7. Kilpatrick SJ, Crabtree KE, Kemp A, Geller S. Preventability of maternal deaths: Comparison between Zambian and American
referral hospitals. Obstet Gynecol. 2002;100:321–6. doi: 10.1016/s0029-7844(02)02065-3 DOI: https://doi.org/10.1016/S0029-7844(02)02065-3
8. Gupta, G., Rana, T.S., Karun, S. et al. Spatial pattern and correlates of maternal healthcare utilization in the North Eastern Region of
India: evidence from the National Family Health Survey, 2019–2021. Discov Public Health22, 365 (2025). https://doi.org/10.1186/s12982-025-00660-0 DOI: https://doi.org/10.1186/s12982-025-00660-0
9. International Institute for Population Sciences (IIPS). National Family Health Survey-6 (NFHS-6), 2023–24: State Fact Sheets.
Mumbai: IIPS; 2025.
10. Singh PK, Rai RK, Alagarajan M, Singh L. Determinants of maternity care services utilization among married adolescents in
rural India. PLoS One. 2012;7(2):e31666. DOI: https://doi.org/10.1371/journal.pone.0031666
11. Kumar G, Choudhary TS, Srivastava A, Upadhyay RP, Taneja S, Bahl R, et al. Utilisation, equity and determinants of full antenatal
care in India: analysis from the National Family Health Survey 4. BMCPregnancy Childbirth. 2019;19:327.
12. Paul P, Chouhan P. Socio-demographic factors influencing utilization of maternal health care services in India. Clin Epidemiol
Glob Health. 2020;8(3):666-70. DOI: https://doi.org/10.9745/GHSP-D-20-00229
13. Morgenstern H. Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health. 1995;16:61-81. DOI: https://doi.org/10.1146/annurev.pu.16.050195.000425
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