Pregnancy to postpartum: Analyzing dropouts and socioeconomic predictors of continuum of maternal healthcare in India

Abstract

Background

Continuum of care (CoC) emphasizes the importance of establishing connections between maternal healthcare service provided at various stages throughout pregnancy, labour, and the postpartum period. The objective of this study was to investigate the CoC for maternal health, focusing on recent utilization and dropout pattern and to examine the underlying wealth inequality and its association with the dimensions of women's empowerment.

Material and methods

For our analysis, we focused on mothers who had given birth within the five years preceding the National family health survey (NFHS)-5 survey. Outcome variable, the CoC for maternal health was assessed at three distinct levels: CoC until 4+ antenatal care (ANC), CoC until skilled birth attendance (SBA), CoC until postnatal care (PNC) or complete CoC. Binary logistic regression, concentration curve and index were utilized to address the objectives of the study.

Results

Our study found that 93.8 % of women initiated maternal healthcare with at least one ANC visit, but only 63.1 % completed the recommended 4+ visits. Among them, 94.6 % received SBA, yet only 62 % continued to PNC. A concerning dropout pattern was observed across all states, with even prosperous states like Chandigarh, West Bengal, Goa, Kerala, New Delhi, and Gujarat showing higher dropout rates before PNC than the national average of 38 %. Concentration curves revealed pro-rich inequality in CoC. Women's social independence positively influenced CoC adherence, along with parity, pregnancy intention, wealth index, and region of residence as key determinants.

Conclusion

Our findings reveal significant gaps in the continuum of maternal healthcare, including high dropout rates before postnatal care and persistent wealth-based disparities. Addressing these issues requires targeted policies, greater women's empowerment, and equitable healthcare access. Future research should conduct a comprehensive analysis to understand why dropout rates remain high, even in relatively prosperous states, by examining health system inefficiencies, sociocultural barriers, and policy gaps.