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Background: Despite progress, the prevalence of childhood undernutrition in India remains amongst the highest globally. Objective: We aimed to evaluate the impact of a functional integration interventional package during the antenatal period on childhood growth parameters. Methods: This is a post-interventional follow-up study of a maternal nutrition interventional study conducted between 2018 and 2019 among women in their first trimester of pregnancy from three districts in West Bengal, India. Pregnant women received a package of augmented interventions from study staff which supplemented those provided to them under the state-run programmes, that included body-mass-index measurement at pregnancy registration, monthly weight monitoring, targeted dietary counselling, supervised supplementary nutrition intake and iron-folic acid supplementation during daily anganwadi center visits. In the current follow-up study conducted in 2021, age-matched pregnant women from the same areas who were pregnant during the same period as in the original study and had received standard-of-care under the state-run programmes were recruited into a comparison group. Study staff collected data regarding maternal height and serial weights that were recorded at antenatal visits in 2018-19, and birth and infant characteristics. Child height and weight were measured during the follow-up visit in 2021, which were used to calculate the relative risks of stunting, wasting and underweight using generalized linear models, to understand the sustained impact of the intervention beyond infancy. Eight-hundred-nine mother-child dyads (406 intervention; 403 comparison) were followed. Results: Median age of women in the intervention and comparison group was 23 (IQR 20–25) and 25 (IQR 24–27) years respectively. Median gestational-weight-gain was higher amongst intervention group women (9 vs. 8 kg, p = 0.04). Low-birth-weight prevalence was 29.3% (119/406) and 32.0% (129/403) in the intervention and comparison group. At 12–35 months of age, children born to women in the intervention group had significantly reduced risk of stunting (RR = 0.65, 95% CI 0.44–0.94), wasting (RR = 0.57, 95% CI 0.33–0.97) and underweight (RR = 0.61, 95% CI 0.42–0.88). Conclusions: These results indicate that functional integration and strengthening of routine antenatal care services including targeted nutritional counselling to expectant mothers can have distal beneficial effects on childhood undernutrition beyond the immediate post-natal period. [ABSTRACT FROM AUTHOR]

Background: Utilization of maternal healthcare services has a direct bearing on maternal mortality but is contingent on a wide range of socioeconomic factors, including the sex of the household head. This paper studies the role of the sex of the household head in the utilization of maternal healthcare services in India using data from the National Family Health Survey-V (2019–2021). Methods: The outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest. Results: 24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves. Conclusion: The results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses. Trial Registration: Not Applicable. JEL Classification: D10, I12, J16. [ABSTRACT FROM AUTHOR]

Background: VHSND, a community platform bringing health, early childhood development, nutrition, and sanitation services by community engagement was affected by COVID-19 pandemic. Aims & Objectives: To assess the process of VHSND implementation during post-pandemic period in Assam. Methodology: This cross-sectional study was conducted as operational research in five districts of Assam, selected based on zonal representation; between Sept '2021- Aug '2022. Standard format (GOI) was used for VHSND monitoring. Descriptive analysis was done along with quarter-wise comparison of observations and knowledge of Auxiliary Nurse and Midwife (ANM). Results: A total of 370 VHSND sessions were observed. VHSND micro plan availability increased from 87.5% to 98.4% over four quarters. Displaying banners varied between 56.3% and 79.5%, and functional toilets increased from 41.3% to 77%. Height measurement improved from 58.8% to 88.5%. Haemoglobin estimation varied between 46.3% and 75.4%. Recognition of high-risk pregnancies due to severe anaemia increased from 60% to 91.8%. Regarding danger signs like bleeding from vagina increased from 50.0% to 95.1%. Conclusion: Notable progress could be documented in logistical readiness and ANM knowledge in different quarters in post-pandemic period. While service delivery and ANM counselling efforts have seen improvement, targeted interventions remain crucial for optimizing maternal and child health outcomes in the region. Keywords Village Health Sanitation and Nutrition Day/ VHND; Nutrition services; Assam; Antenatal Care; Supplies & Equipment [ABSTRACT FROM AUTHOR]

Background: Physiological and hormonal changes during pregnancy can alter the sleep patterns of the pregnant women and were said to be precursor for the development of obstructive sleep apnea (OSA) and complication of pre-existing OSA. Developing country like India has no health cost distribution for the treatment, as this condition's treatment trends absorbs 65-82% of all health cost. There is oblivious state among clinicians and patients, self-reporting of the symptoms are poor which, in turn, results to upshot underdiagnoses of OSA among southern Indian population. Aims and Objectives: The aim of the study is to screen the prevalence of OSA among the southern Indian pregnant women attending antenatal care and to evaluate its predisposing factors. Materials and Methods: We enrolled 305 pregnant women according to our study selection criteria, attended antenatal care at ACS medical college and hospitals from Chennai. On face-to-face basis, berlin questionnaire screening was done. With a brief interview, sociodemographic details, medical records and laboratory parameters were obtained. To cluster the risk of OSA prevalence, percentage was estimated using frequency distribution. Chi-square analysis was done to obtain significant relationship between contributing factors and OSA symptoms. Statistical testing was done with SPSS software version 21. Results: Among 305 pregnant women, 31.8% (97) were shown to have high-risk OSA and 68.2% (208) low-risk OSA. Across the trimester, highrisk OSA were noted among 8.2% (25), 11.1% (34), and 15.4% (48) at first, second, and third trimester, respectively. Age, body mass index, occupation, neck circumference, multiple pregnancy, and presence of conditions such as gestational hypertension, chronic hypertension, adenoids, mallampatti grade, nasal congestion, and family history of OSA can be the predisposing factors which could influence the OSA symptoms. Conclusion: The future investigations should rely on the analysis of the fetal outcomes after proper diagnosis of OSA. Furthermore, independent predictive values of physical signs, history, risk factors, and mechanisms behind the progression of OSA should be studied well. Region and area specific difference of risk of OSA to identify disparities and to promote decentralization of sleep care could be done. [ABSTRACT FROM AUTHOR]

• Government health care services are the primary source of maternal care for the tribes (indigenous communities). • Particularly vulnerable tribal groups are at risk of foregoing antenatal care and are more likely to give childbirth at home. • Health workers' home visits and advice significantly and positively influence maternal healthcare-seeking behaviour. • Maternal education and having all-weather roads are crucial determinants for institutional childbirths. • Certain socio-cultural practices (early marriages leading to teenage pregnancies) need to be addressed. To report the utilisation of maternal healthcare services and factors associated with adequate antenatal care and institutional childbirths among mothers in the tribal communities from nine districts in India. Cross-sectional data were collected from 2636 tribal women who had a childbirth experience in the past 12 months. Socio-demographic, maternal healthcare services and health system-related details were collected. Multiple logistic regression analyses were done to identify factors associated with adequate antenatal care (receiving at least four antenatal care visits, the first visit being in the first trimester and receiving a minimum of 100 iron-folic acid tablets) and institutional childbirth (mother giving birth in a health facility). Only 23% of the mothers received adequate antenatal care. 82% were institutional childbirths. The logistic regression revealed that particularly vulnerable tribal groups (PVTGs), those lacking all-weather roads, and women of advanced age were at risk of inadequate antenatal care. Mother's education, health worker's home visits during pregnancy and reception of advice on antenatal care were significantly associated with the reception of adequate antenatal care. Having all-weather roads, and education of the mother and head of the household were positively associated with institutional childbirths, whereas PVTGs, children of birth order three or above, and working mothers were more likely to give childbirth at home. PVTGs are at risk of foregoing adequate antenatal care and are more likely to give childbirth at home. Having all-weather roads is a strong correlate of adequate maternal care. Outreach activities by the health workers are to be strengthened as they are positively and significantly associated with the reception of adequate antenatal care. Investing in education and other social determinants and addressing certain socio-cultural practices is important to improve maternal health. [ABSTRACT FROM AUTHOR]

Background: The district Nuh has been declared as the most backward district of Haryana state and is also listed among the 108 most backward districts of India identified by the National Institute for Transformation of India (NITI) Aayog. National Family Health Survey-4 (NFHS-4) conducted during 2015-16 reported that only 6.5% of mothers utilize four antenatal check-ups in district Nuh. This study was carried out to estimate the coverage of antenatal care services in district Nuh. Methods: A total of 300 pregnant women who were in their 1st trimester were recruited from the rural area of Primary Health Centre Nagina starting from January 2022 till December 2022. All eligible study participants were interviewed through house-to-house visits to assess the coverage of antenatal care received by them. Results: A total of 83 (27.6%) participants were primigravida, and 217 (72.3%) were multigravida. Only 25 (8.33%) participants reported receiving full antenatal care services which include early registration of pregnancy (within 12 weeks), a minimum of four ANC visits, at least one dose of diphtheria-tetanus toxoid vaccine, and 100 days of iron & folic acid supplementation. Conclusion: The coverage of antenatal care services received by pregnant women is low despite the availability of free government services. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related complications and insufficiencies in antenatal care services are leading causes of maternal and infant morbidity and mortality in low-resource settings. However, there has been an undue focus on achieving a minimum number of Antenatal Care (ANC) visits without adequate focus on the factors affecting ANC service utilization. This secondary data analysis from the fifth round of the National Family Health Survey (NFHS-5, 2019-21) was conducted to estimate the coverage of adequate quality ANC service and its determinants in India. Methods: The study sample included 176,877 women aged 15–49 years who had experienced a pregnancy in the last 5 years. The primary outcome variable was the utilization of ANC services by women during their last pregnancy assessed by the frequency of ANC visits and the quality of ANC services. Quality of ANC service utilisation was categorised as adequate quality, inadequate quality and ≥ 4 ANC visits and, inadequate quality and < 4 ANC visits. We performed multinomial logistic regression and reported relative risk ratio (RRR) along with 95% confidence intervals. We adjusted for sampling weight, clustering, and stratification in the sampling design. Results: The median (IQR) number of ANC visits attended by a woman during her previous pregnancy was 4 (IQR 3–7). A majority (59.25%) of the women reported availing of ≥ 4 antenatal care (ANC) visits during their previous pregnancy while 6.12% of women reported availing no ANC visits in their last pregnancy. Women aged ≥ 30 years were significantly less likely (aRRR 0.73 95% CI 0.66, 0.80) to receive ANC services of inadequate quality, and < 4 ANC visits. Additionally, any exposure to mass media (aRRR 0.69 95% CI 0.66, 0.73), and having health insurance (aRRR 0.71 95% CI 0.68, 0.75) decreased their risk of receiving inadequate quality ANC services and < 4 ANC visits. Women belonging to the richest wealth quintile (aRRR 0.52 95% CI 0.47,0.58) and those with an intended pregnancy (aRRR 0.62 95% CI 0.58 ,0.66) were at significantly lower risk of utilizing inadequate quality ANC services and < 4 ANC visits. Conclusion: Although nearly 3 in 5 women in India utilized a minimum mandated ≥ 4 ANC visits during their last pregnancy, only one in five of those received adequate quality of ANC services indicating suboptimal content. However, only one in five women utilized the WHO-mandated ≥ 8 ANC visits for a positive pregnancy experience. Furthermore, 14.3% of the women received ANC services of inadequate quality despite attending ≥ 4 ANC visits in their previous pregnancy. Our study emphasized the importance of the quality of ANC services utilised irrespective of number of ANC visits availed. Efforts should be undertaken to enhance the utilization of antenatal care (ANC) services by implementing media initiatives that aim to raise awareness, particularly among women belonging to disadvantaged population groups. [ABSTRACT FROM AUTHOR]

Background: Anemia is one of the contributing factors for morbidity and mortality during pregnancy in developing country including India, which eventually leads to fetal and maternal consequences. Growing fetus depends completely on mothers for all its growth and maturity. Anemia is one of the nutritional deficiency disorders and around 56% of women are suffering from anemia in India. It is one of the reasons for maternal deaths and fetal complication during pregnancy. Aim: The aim of the study was to assess the prevalence of anemia and to determine the risk factors of anemia among pregnant women in PBMH hospital, Bhubaneswar, Odisha. Materials and Methods: A descriptive cross-sectional study was conducted over a period of 1 month from October 11, 2022, to November 11, 2022, from the Department of Obstetrics and Gynecology of Pradyumna Bal Memorial Hospital KIMS, Bhubaneswar. A total sample comprised of 52 pregnant women who were interviewed by using self-structured questionnaire for data collection and classification of anemia was performed according to the Indian Council of Medical Research (ICMR) criteria. Results: A total of 52 antenatal mothers were admitted during this study period (October 11, 2022, to November 11, 2022), and all were selected as study sample. The incidence of anemia among antenatal mother in PBM hospital was found as follows: 17 (33%) mild, 04 (07%) moderate, and 02 (04%) were severe in this present study. The most common indication of anemia among antenatal mother as per the present study was found to be H/O infection (21%), chronic malaria (15%), hook worm (27%), and birth interval (42%). Conclusion: The study implies that the prevalence rate of Anemia is high, that is, 44.2%. Spacing between pregnancy and H/O infection plays a significant role in considering anemia in pregnant women, which eventually affects both maternal and fetal condition. [ABSTRACT FROM AUTHOR]

This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2–7 days and at 2–28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality. Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used. Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths. Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2–7 days and 2–28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2–7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2–7 days and at 2–28 days. The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality. [ABSTRACT FROM AUTHOR]

Women's abuse is a global health problem that erodes their self-esteem and saps their energy. Research evidence for India mainly focusses on use of reproductive healthcare services by women based on their experience of intimate partner violence during pregnancy. We hypothesise that non-partner violence during pregnancy can be equally detrimental for women and their children's well-being. As this aspect remains unexplored, we investigate the relationship between physical non-partner violence (PNPV) faced by women during pregnancy in India and utilisation of three reproductive healthcare services by them, namely antenatal care, institutional delivery and postnatal checks. Using data from the fourth round of the National Family Health Survey and employing binary multivariable logistic regression models under the framework of the Andersen–Newman Behavioural Model of health services utilisation, we find that women who experience PNPV during pregnancy are significantly more likely to give birth in a medical facility but less likely to make use of postnatal care services. Thus, recognising the connection between violence during pregnancy and the utilisation of maternal health services can enable healthcare and other social support organisations to identify the unique needs of pregnant women experiencing abuse and help in reducing such violence from happening in the first place. [ABSTRACT FROM AUTHOR]

Background: The persistently high rates of maternal mortality and morbidity among historically marginalised social groups, such as adolescent Scheduled Castes (SCs) and Scheduled Tribes (STs) in India, can be attributed, in part, to the low utilisation of full antenatal healthcare services. Despite efforts by the Indian government, full antenatal care (ANC) usage remains low among this population. To address this issue, it is crucial to determine the factors that influence the utilisation of ANC services among adolescent SC/ST mothers. However, to date, no national-level comprehensive study in India has specifically examined this issue for this population. Our study aims to address this research gap and contribute to the understanding of how to improve the utilisation of ANC services among adolescent SC/ST mothers in India. Data and methods: Data from the fourth round of the National Family Health Survey 2015–16 (NFHS-4) was used. The outcome variable was full antenatal care (ANC). A pregnant mother was considered to have 'full ANC' only when she had at least four ANC visits, at least two tetanus toxoid (TT) injections, and consumed 100 or more iron-folic acid (IFA) tablets/syrup during her pregnancy. Bivariate analysis was used to examine the disparity in the coverage of full ANC. In addition, binary logistic regression was used to understand the net effect of predictor variables on the coverage of full ANC. Results: The utilisation of full antenatal care (ANC) among adolescent SC/ST mothers was inadequate, with only 18% receiving full ANC. Although 83% of Indian adolescent SC/ST mothers received two or more TT injections, the utilisation of the other two vital components of full ANC was low, with only 46% making four or more ANC visits and 28% consuming the recommended number of IFA tablets or equivalent amount of IFA syrup. There were statistically significant differences in the utilisation of full ANC based on the background characteristics of the participants. The statistical analysis showed that there was a significant association between the receipt of full ANC and factors such as religion (OR = 0.143, CI = 0.044–0.459), household wealth (OR = 5.505, CI = 1.804–16.800), interaction with frontline health workers (OR = 1.821, CI = 1.241–2.670), and region of residence in the Southern region (OR = 3.575, CI = 1.917–6.664). Conclusion: In conclusion, the study highlights the low utilisation of full antenatal care services among Indian adolescent SC/ST mothers, with only a minority receiving the recommended number of ANC visits and consuming the required amount of IFA tablets/syrup. Addressing social determinants of health and recognising the role of frontline workers can be crucial in improving full ANC coverage among this vulnerable population. Furthermore, targeted interventions tailored to the unique needs of different subgroups of adolescent SC/ST mothers are necessary to achieve optimal maternal and child health outcomes. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has interrupted many activities across the country and the state of Kerala is not an exception. Although Kerala is frequently held up as an example for the rest of India in various social indicators. Despite Kerala's goal of lowering the maternal mortality rate to 30 it has increased to 66 in 2021, most likely due to COVID-19. This study investigated it. Data on key health service delivery to maternal and child health for all 24 months of the pre-COVID (2019-20) and COVID (2020-21) period were gathered from the HMIS, India, and the DHS, Kerala. For variables with normally distributed data, the paired sample t-test is performed and for variables with non-normally distributed data, the Wilcoxon signed-rank test is performed to compare the pre-covid and the covid period data of key health indicators of service delivery to mother and child healthcare. An Average Increasing Rate (AIR) or Average Reduction Rate (ARR) for the pre-covid period (2019-20) and the covid period (2020-21) has been calculated. The result shows that there is a significant impact of COVID-19 in full antenatal care, delivery care, child immunisation and maternal mortality albeit for a short period. When comparing full antenatal care during the COVID and pre-COVID periods, all services except the distribution of calcium tablets reveal a decline in service delivery. Because of having a high literacy rate, a solid health infrastructure, a proactive administration, and enough disaster management experience, the state mostly managed to deliver uninterrupted basic healthcare to its population and able to reduce the impact of COVID-19.However a more robust and dynamic healthcare system is required to be in place to mitigate the impact of these types of pandemics or any such kind of external shocks which are more frequent and enormous in scale. [ABSTRACT FROM AUTHOR]

Background: The north-eastern part of India, dominated by a population belonging to various tribal communities, possesses diverse socioeconomic characteristics. The variation across communities in terms of availing maternity care is linked to socioeconomic traits. Objective: To conduct a comparative performance appraisal of all 16 regions in North-East India regarding the availing of maternity care and explore the linkage between each state's socioeconomic characteristics and its relative success in delivering maternity care. Methods: The study is based on the data from India's National Family Health Survey (NFHS - 4). We considered a total of 16 geographical areas, 11 criteria of maternity care, and 17 socioeconomic characteristics. We utilized hybrid models of AHP-TOPSIS and Entropy-TOPSIS for the ordinal evaluation of the regions concerning the delivery of maternity care and socioeconomic attainments. Finally, we analysed the associations between the two. Results: The ordinal evaluations rank all 16 regions regarding socioeconomic attainments and the delivery of maternity care. The study finds that Manipur, as a state, excels in delivering maternity care, while Meghalaya is the poorest performer. Female literacy, female educational attainment, male literacy, and female fertility are critical factors significantly impacting women's availing of maternity care. [ABSTRACT FROM AUTHOR]

Mortalities and morbidities related to reproductive health continue to remain higher among tribal communities in the state of Telangana despite the availability of various health initiatives and incentive schemes. The present study aims to determine the maternal factors associated with reproductive outcomes among Particularly Vulnerable Tribal Groups (PVTGs) such as the Chenchu and the Andh and the most numerically dominant tribal groups such as the Koya, the Lambada and the Gond. The study was conducted in eight mandals of four Integrated Tribal Development Agencies (ITDAs) in the state of Telangana. All the households in the villages falling under the jurisdiction of these mandals were covered. A total number of 1599 women were included in this study. Structured schedules were used for data collection in this survey. Results showed that there has been a significantly low occurrence of pre-term deliveries; the proportion of live births increased dramatically among the study participants due to their pronounced use of antenatal care and institutional delivery services. Some relaxations regarding norms such as age at marriage, the spacing between births, and reproductive decision-making were also observed. There were significant differences among the tribal groups with respect to the age at first conception, birth weights, and the time interval between the conception and confirmation of pregnancy by the health staff. There is no significant association between acceptance of Ante Natal Care (ANC) by the PVTGs and non-PVTGs and between birth order and acceptance of ANC by the PVTGs and non-PVTGs. Similarly, no statistically significant inter-tribal variation is found in birth weight. [ABSTRACT FROM AUTHOR]

Background: India contributes 15% of the total global maternal mortality burden. An increasing proportion of these deaths are due to Pregnancy Induced Hypertension (PIH), Gestational Diabetes Mellitus (GDM), and anaemia. This study aims to evaluate the effectiveness of a tablet-based electronic decision-support system (EDSS) to enhance routine antenatal care (ANC) and improve the screening and management of PIH, GDM, and anaemia in pregnancy in primary healthcare facilities of Telangana, India. The EDSS will work at two levels of primary health facilities and is customized for three cadres of healthcare providers – Auxiliary Nurse Midwifes (ANMs), staff nurses, and physicians (Medical Officers). Methods: This will be a cluster randomized controlled trial involving 66 clusters with a total of 1320 women in both the intervention and control arms. Each cluster will include three health facilities—one Primary Health Centre (PHC) and two linked sub-centers (SC). In the facilities under the intervention arm, ANMs, staff nurses, and Medical Officers will use the EDSS while providing ANC for all pregnant women. Facilities in the control arm will continue to provide ANC services using the existing standard of care in Telangana. The primary outcome is ANC quality, measured as provision of a composite of four selected ANC components (measurement of blood pressure, blood glucose, hemoglobin levels, and conducting a urinary dipstick test) by the healthcare providers per visit, observed over two visits. Trained field research staff will collect outcome data via an observation checklist. Discussion: To our knowledge, this is the first trial in India to evaluate an EDSS, targeted to enhance the quality of ANC and improve the screening and management of PIH, GDM, and anaemia, for multiple levels of health facilities and several cadres of healthcare providers. If effective, insights from the trial on the feasibility and cost of implementing the EDSS can inform potential national scale-up. Lessons learned from this trial will also inform recommendations for designing and upscaling similar mHealth interventions in other low and middle-income countries. Trial Registration. ClinicalTrials.gov, NCT03700034, registered 9 Oct 2018, https://www.clinicaltrials.gov/ct2/show/NCT03700034 CTRI, CTRI/2019/01/016857, registered on 3 Mar 2019, http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=28627&EncHid=&modid=&compid=%27,%2728627det%27 [ABSTRACT FROM AUTHOR]

This article analyzes the factors influencing the utilization of antenatal care (ANC) services throughout pregnancy and the way it is managed. Antenatal care from qualified medical professionals gives expectant mothers the attention they need to achieve the best possible health for both the mother and the unborn child during pregnancy. Those care providers are supposed to facilitate women with information and assistance throughout the pregnancy and afterward. ANC services are the initial step in ensuring the health of the mother and child which is one of the basic needs during pregnancy. But for many pregnant women, notably in low- and middle-income countries, where a variety of dietary deficits typically coexist, awareness of healthy pregnancy and dietary consumption of nutritious food are frequently insufficient to meet these needs. Services of medical professionals are either inadequate or inappropriate in many of those regions. By examining the experiences of selected women from the Mountgaon district of Assam, this study looks at the factors affecting the accessibility of antenatal services for women. The study clarifies the lower-than-average use of healthcare services in the targeted area because of the non-availability of facilities, lapse in the proper healthcare management and socio-cultural peculiarities relating to women and their families. The analysis shows the impact of socio-economic and cultural factors on health-seeking behaviour as well as the usage of the available healthcare facilities. [ABSTRACT FROM AUTHOR]

Introduction: India is a major contributor to both maternal and neonatal death worldwide. Majority of these fatalities can be averted by adequate utilization of Antenatal care (ANC) services. Large scale surveys like National Family Health Survey follow hieratical characters in which subjects within the clusters are often correlated. The ordinary logistic model ignores this correlation and provide compromised estimate of effect size of predictors. Multilevel model that incorporates correlation is the appropriate method. Aim: To demonstrate the adequacy of multilevel logistic model over ordinary logistic model in hieratical data sets with ANC visits >4 and delivery assisted by Skilled Birth Attendant (SBA). Materials and Methods: This retrospective, cross-sectional study was conducted at the Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from October 2021 to March 2022. The data of 174607 women, who delivered the children within five years, obtained using cluster sampling, from country wide survey during 20th January 2015 to 4th December 2016 (India's National Family Health Survey-IV) was used. Firstly, the model adequacy of ordinary and multilevel logistic models was evaluated for ANC ≤4 visits and delivery assisted by SBA, the same data set of fourth round National Family Health Survey by considering the outcomes;. Thereafter, predictors of late or no registration of pregnancy were identified using three level logistic model. Results: Because of high Variance Partition Coefficients (VPC) at state and district levels, the multilevel model applied on components ANC ≥4 visits and delivery assisted by SBA suggested better accuracy of the multilevel logistic model (-2Log L=189334 for ANC ≥4 visits and 141148 for delivery assisted by SBA) than the ordinary logistic model (-2Log L=220268 for ANC ≥4 visits and 151978 for delivery assisted by SBA). For the late (registration in third trimester of pregnancy) or no registration of pregnancy, each predictor was found significantly associated in which the most important were women's education, child birth order, caste and wealth quintile. Conclusion: The present study concluded that multilevel logistic model in clustered design data was useful instead of individual level for more precise estimate of effect size of the predictors. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is the most crucial thing for every mother. Providing appropriate health-care services during pregnancy by skilled health care professionals is important for healthy childbirth and better maternal health outcomes. Despite Antenatal care services being free at the Public Hospital in Sikkim, many pregnant women are reluctant to get ANC services because of many socio-economic and demographic factors. Objectives: The present study aimed to identify various socio-economic and demographic determinants affecting ANC services utilization among rural women of South Sikkim, India. Methods: The community-based cross-sectional study was carried out among 250 reproductive-aged (15-49 years) women residing in South Sikkim, India. The data on various socio-economic and demographic determinants associated with utilization of antenatal care services were collected by adopting a pre-structured schedule interview method by household visits. Results: A total of 73.4% reported that they have utilized the ANC services among women in South Sikkim. Binary logistic regression analysis indicated that several socio-economic and demographic variables of age, age at marriage, age at pregnancy, marital status, family income, education, education of husband, occupation of husband parity and family income were significantly associated with ANC visits (p<0.05), except women's occupation and religion (p>0.05). Conclusion: There is an urgent need to inform pregnant women and their families about the importance of ANC services to enhance effective utilization and improve the overall health status. [ABSTRACT FROM AUTHOR]

Background: Antenatal care coverage has dramatically increased in many low-and middle-income settings, including in the state of Telangana, India. However, there is increasing evidence of shortfalls in the quality of care women receive during their pregnancies. This study aims to examine dimensions of antenatal care quality in Telangana, India using four primary and secondary data sources.Methods: Data from two secondary statewide data sources (National Family Health Survey (NFHS-5), 2019-21; Health Management Information System (HMIS), 2019-20) and two primary data sources (a facility survey in 19 primary health centres and sub-centres in selected districts of Telangana; and observations of 36 antenatal care consultations at these facilities) were descriptively analysed.Results: NFHS-5 data showed about 73% of women in Telangana received all six assessed antenatal care components during pregnancy. HMIS data showed high coverage of antenatal care visits but differences in levels of screening, with high coverage of haemoglobin tests for anaemia but low coverage of testing for gestational diabetes and syphilis. The facility survey found missing equipment for several key antenatal care services. Antenatal care observations found blood pressure measurement and physical examinations had high coverage and were generally performed correctly. There were substantial deficiencies in symptom checking and communication between the woman and provider. Women were asked if they had any questions in 22% of consultations. Only one woman was asked about her mental health. Counselling of women on at least one of the ten items relating to birth preparedness and on at least one of six danger signs occurred in 58% and 36% of consultations, respectively.Conclusion: Despite high coverage of antenatal care services and some essential maternal and foetal assessments, substantial quality gaps remained, particularly in communication between healthcare providers and pregnant women and in availability of key services. Progress towards achieving high quality in both content and experience of antenatal care requires addressing service gaps and developing better measures to capture and improve women's experiences of care. [ABSTRACT FROM AUTHOR]

Preterm birth (PTB) increases the risk of various acute and chronic morbidities and premature mortality in children under 5 years of age. The present study examines the association between different maternal obstetric factors and PTB. In addition, this study estimates the risk of neonatal mortality among children born preterm. Retrospective two-stage stratified sample design. The weighted prevalence of PTB was estimated using data on 148,746 most recent institutional births from the National Family Health Survey (NFHS)-4, 2015–16. The Poisson regression model was used to investigate the association between maternal obstetric factors and PTB. Using Cox's proportional hazard model, the risk of neonatal mortality among PTBs was estimated. Maternal obstetric factors, such as minimal antenatal care, delivery complications, history of previous caesarean delivery and delivery at private health facilities, were significantly associated with an increased risk of PTB. The survival probability of preterm babies sharply declined in the first week of life and thereafter was found to stabilise. The risk of mortality in the first 28 days of life increased 2.5-fold if the baby was born preterm. Optimising antenatal care was found to lower the likelihood of PTB and improve their chances of survival. Antenatal care services and delivery care practices in private facilities were strongly associated with the incidence and survival of PTB. Evaluating associations of history of caesarean births on future pregnancies can help understand their deleterious effects on PTB. Affordable, accessible and available antenatal care services, in both public and private facilities, can increase the survival rates of PTBs. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic affected antenatal care in many parts of the world. It brought about many changes as part of control and containment measures. We examined the effect of the first and second waves of the pandemic in India on stillbirth rates, as indicators of quality of maternity care. Observational study at a tertiary referral perinatal centre with approximately 10,000 births annually. The Covid-19 first wave period was taken as January to December 2020 with lockdown March to June 2020, which included complete shut down of clinics and ultrasound services. The second wave was from January to September 2021. All women with singleton pregnancy who had hospital based antenatal care were included. We investigated monthly trends in obstetric load (new antenatal registrations, total obstetric clinic numbers and total births) with stillbirth numbers as the pandemic continued (daily Covid case trend). We compared first and second wave stillbirth rates, overall as well as those that were small for gestational age (<10th centile) at delivery. There were 9,251 births with 32 stillbirths in the first wave (rate 3.46/1,000) and 6,228 births with 14 stillbirths in the second wave (2.25/1,000). This represented a 54% higher rate in the first phase and extended lockdown period (p=0.08). The incidence of stillbirths that were SGA was significantly higher in the first wave: 14 vs. 2, (p=0.03). Reduced access to planned antenatal care during Covid-19 pandemic lockdown was associated with a significant increase in SGA stillbirths. [ABSTRACT FROM AUTHOR]

Background: Eclampsia is a major cause of perinatal mortality. There is a need for studies that will correlate maternal factors and perinatal outcome, which will provide potential strategies to improve fetal outcomes in pregnancies complicated by eclampsia. Aims and Objectives: This study aims to study perinatal outcome of babies born to mothers with antepartum eclampsia and to correlate outcomes with convulsion delivery interval. Materials and Methods: A study included 200 patients diagnosed and managed as antepartum eclampsia in the Department of Obstetrics and Gynaecology in MGM Medical College, Indore. A detailed pro forma was prepared and was filled with patient’s information, investigations, treatment, and birth details. The final outcome of both, the mother and her newborn, including stillbirths and early neonatal deaths was included in the study and the perinatal outcome was correlated with convulsion delivery interval. Results: Incidence of antepartum eclampsia in our study was 2.1%. About 86.4% of women lack regular antenatal care at health care center. Only 7% of women delivered within 6 h of onset of convulsion. Case fatality rate was found to be 13%. There were 59.5% premature deliveries. Perinatal mortality (stillbirth and early neonatal deaths) was 42.5%. Significant association was found between convulsion delivery interval and perinatal outcome (P<0.05). Furthermore, association between use of multiple antiepileptic agents and perinatal outcomes was statistically significant. Conclusion: Eclampsia being a major cause of perinatal mortality need early diagnosis, prompt referral from peripheral health centers, and timely intervention for improvising both perinatal and maternal outcomes. [ABSTRACT FROM AUTHOR]

Spontaneous uterine rupture is a rare obstetric complication that has catastrophic effects on both the mother and foetus, resulting in significant morbidity and 80 to 90% foetal mortality. Rupture of the uterus through a previous lower uterine segment scar is the most common cause in developing nations. However, factors such as lack of antenatal care, inappropriate obstetric interventions, obstructed labour, grand multiparity, unbooked status, limited access to emergency obstetric care, and low socioeconomic status play a crucial role in uterine rupture in developing countries like India. Hereby, the authors present a case report of a 31-year-old pregnant patient at 19 weeks of gestation with sudden severe lower abdominal pain. An ultrasound revealed the absence of foetal cardiac activity, placenta located outside the uterus, an empty endometrial cavity, and minimal free fluid in the pelvis. Further, an Magnetic Resonance Imaging (MRI) of the pelvis showed a rupture of the anterior and right lateral uterine wall, through which the foetus and most of the placental tissue had passed into the peritoneal cavity. After confirming the diagnosis, the patient underwent emergency laparotomy, during which the uterine wall defect was closed with appropriate haemostasis. The patient recovered without any untoward complications. [ABSTRACT FROM AUTHOR]

Background: In India, there is currently a lack of data on socioeconomic inequalities in HIV testing on a national scale; thus, understanding socioeconomic inequalities in response to expanded HIV testing is critical for assessing and ensuring equity of HIV programmes in accordance with the Sustainable Development Goals. The specific objective of the study was to determine the factor associated with HIV testing during antenatal care and assess the socio-economic inequalities in HIV testing during antenatal care (ANC) among Indian women aged 15-49 years with a live birth in the two years preceding the survey.Methods: The results drawn from the state module of women data file of fourth round of National Family Health Survey (NFHS-4, 2015-16), considering HIV testing during antenatal care among women aged 15-49 who gave live birth in the two years preceding the survey and received the result of HIV test as a matter of fact. Method, such as, descriptive statistics, binary ogistic regression, concentration index were used in the analysis.Results: The findings of the study show that HIV testing during antenatal care was low (30%) among women in India. Our findings reveal that there were significant inequalities exist in HIV testing during ANC between richer and poorer quintile of women. Education, place of residence, comprehensive knowledge of HIV/AIDS, and regular exposure of mass media were substantially contributing to socioeconomic inequality in HIV testing during ANC among women in India.Conclusions: The socioeconomic inequities in HIV testing during pregnancy should be monitored and addressed in order to ensure an equitable distribution of the benefits specially among children and accomplishments of HIV programs in India. [ABSTRACT FROM AUTHOR]

Background: Pregnancy and childbirth, especially in high-risk women, necessitate proper antenatal, intranatal, and immediate postpartum care. Early detection of complications and prompt referral to the higher level of care can reduce the associated adverse maternal outcomes. Aims and Objectives: The aim of the study was to evaluate the spectrum of pregnancy-related referrals to our hospitals and their outcomes. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, B.R.D Medical College, Gorakhpur, U.P, India, over a period of 1 year (October 2020-September 2021). All the referred cases of obstetric indications =28 weeks of gestation were analyzed for reasons of referral and their outcomes. Results: Obstetrics referral accounted for 31.15% of the total obstetrics admissions (1416/4545). The average age of study participants was 26.92 years and majority being primigravida. The major reasons for referring patient were hypertensive disorders of pregnancy (16.74%), previous cesarean section (12.78%), and severe anemia (7.70%). There were 70 maternal deaths leading to case fatality rate of 4.94% while 94.2% of patient were discharged healthy. Conclusion: Lack of knowledge, ignorance, and poor transport facilities are major contributors of poor pregnancy outcome. Timely and appropriate referral is crucial in improving maternal outcome. Improvement in the quality of Maternal Child Health care at Primary Health Centre, Community Health Centre level; regular training of health-care providers in emergency obstetrics care is required to curb unnecessary referrals and consequently in reducing fetomaternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Telemedicine facilitates patient care in various fields including antenatal care. Its application and usefulness need objectification and can be a guide to using this service in the care of pregnant women. Material and Methods: This was a prospective observational study conducted from May 2020 to December 2020. Following the telemedicine practice guideline of the country, 3,360 teleconsultations were sought by 862 antenatal patients. The duration of each call, an indication of referral and pregnancy risk stratification were noted. Further management was classified into three categories depending upon the need for an immediate hospital visit, no hospital visit or scheduled visit after at least 48 h after the first contact. Results: The antenatal cases were referred for either maternal, foetal or both indications in 24.7, 54.8 and 20.5% of the cases, respectively. Women were classified as low risk (61.6%), high risk (35.7%) and severe risk (2.7%). In 1.4% of the patients, history and review of the records could not be done through telemedicine. The average time spent was 16.6 min for the first contact and 3.1 min for subsequent contacts. Further management was done with immediate visits in 385 (45.3%), scheduled hospital visits in 292 (34.3%) women and no tertiary care hospital visit in 173 (20.4%). Discussion: Women (20.4%) not called to the maternal-foetal medicine department of the institute were managed along with the treating obstetrician and no difference in pregnancy outcome was noted. Conclusion: Antenatal care can be provided following triage over teleconsultation and 1.4% of the women may not be able to use telehealth. [ABSTRACT FROM AUTHOR]

Introduction: The engagement of the expectant father in the pregnancy and birth of the child has an impact on the pregnancy result. It lowers the risk of preterm birth, low birth weight, foetal growth restriction, and infant death by reducing unfavourable maternal health behaviours. The role of the expectant father is critical in identifying difficulties throughout pregnancy. With this backdrop in mind, the goal of the study is to analyse the attitudes and practises of expectant dads on pregnant women when it comes to antenatal care. Methods: A cross-sectional study was done among 100 pregnant fathers attending an antenatal clinic. Using a structured questionnaire and observational check list, prejudices and practice of these individuals was analyzed. Results: In the majority of families (58 %), husbands made the decisions. Moreover half (58.2%) of the 100 expectant fathers polled, reported that health care facility was visited only if there was a difficulty. Only 20% of men preferred to accompany their women to prenatal appointments. The majority of them believed that their primary responsibility was to provide financial assistance. Conclusion: Most of the prospective fathers have a good understanding of antenatal care, although its relevance is not fully appreciated. Expectant fathers accompanying their wives to antenatal appointments will aid not only in the utilization of antenatal services, but also in the early detection and treatment of difficulties. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the effect of a mHealth (text message) intervention compared with a structured health educational session on the oral care and hygiene practices of pregnant women. Materials and Methods: We conducted a pilot randomized control trial, parallel design superiority trial, with a 1:1 allocation ratio. A total of 76 pregnant women up to 20 weeks of gestational age and capable of reading mobile phone text messages were recruited during August–October 2020 from the antenatal clinic of a primary health center in a low-income urban agglomeration in Delhi, India. The mHealth intervention arm participants were sent a daily text message for 30 days, while all participants were provided a one-time, face-face, brief didactic structured educational session toward oral health promotion. Results: The baseline characteristics of both groups were comparable in terms of age structure, education, parity, and oral hygiene but differed in terms of oral health problems. Postintervention, although the twice-brushing frequency increased in both arms, only the mHealth arm revealed a statistically significant reduction in the incidence of missed twice-daily brushing episodes (P = 0.016). Conclusions: A mHealth-based daily text-message intervention for 1 month was not superior to a one-time brief didactic structured educational intervention for oral health promotion in antenatal women. [ABSTRACT FROM AUTHOR]

The utilisation of maternal healthcare services is a principal indicator to measure the success of any maternal and child health programme. Suboptimal utilisation of maternal healthcare services is a vexatious problem in Empowered Action Group (EAG) states of India. This study aims to examine the currents status and socioeconomic determinants of antenatal services, skilled birth attendance and post‐natal services in four infamous EAG states of India. This study used nationally representative, National Family Health Survey (NFHS, 2015–16) data for analysis. Descriptive statistics were used to depict the current status of maternal healthcare services utilisation and a discrete choice model was applied to examine the associated factors across the selected EAG states. The utilisation of maternal health services was higher in Rajasthan followed by Madhya Pradesh, Uttar Pradesh and Bihar respectively. Utilisation was consistently low among the socioeconomically disadvantaged women in all the selected EAG states. The study highlights that female education, mass media exposure, women's autonomy and economic status were significantly associated with the use of maternal healthcare services. The actualisation of our national and Sustainable Development Goals at the ground level is happening relatively slowly in the EAG states. Hence, achieving equitable distribution of resources, universal availability and access to information, counselling and reproductive services coupled with women empowerment are vital to the realisation of these goals. [ABSTRACT FROM AUTHOR]

Background: India, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal mortality could be avoided if the continuum of care (CoC) is provided in a structured pathway from pregnancy to the postpartum period. Therefore, this article attempted to address the following research questions: What is the level of completion along CoC for MNCH services? At which stage of care do women discontinue taking services? and what are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India?Methods: The study utilized the data from the National Family Health Survey (NFHS-4) conducted during 2015-16 in India. The analysis was limited to 107,016 women aged 15-49 who had given a live birth in the last 5 years preceding the survey and whose children had completed 1 year. Four sequential fixed effect logit regression models were fitted to identify the predictors of completion of CoC.Results: Nearly 39% of women in India had completed CoC for maternal and child health by receiving all four types of service (antenatal care, institutional delivery, post-natal care and full immunization of their child), with substantial regional variation ranging from 12 to 81%. The highest number of dropouts in CoC were observed at the first stage with a loss of nearly 38%. Further, education, wealth index, and health insurance coverage emerged as significant factors associated with CoC completion.Conclusion: The major barrier in achieving CoC for maternal and child health is the low utilization of ANC services in the first stage of the continuum and hence should be addressed for increasing CoC completion rate in the country. The gaps across all the levels of CoC indicate a need for increased focus on the CoC approach in India. A strategy should be developed that will connect all the components of MNCH avoiding dropouts and the MNCH provision should be standardized to provide services to every woman and child. [ABSTRACT FROM AUTHOR]

Background: Timely and skilled care is key to reducing maternal and neonatal mortality. Birth preparedness involves preparation for safe childbirth during the antenatal period to reach the appropriate health facility for ensuring safe delivery. Hence, understanding the factors associated with birth preparedness and its significance for safe delivery is essential. This paper aims to assess the levels of birth preparedness, its determinants and association with institutional deliveries in High Priority Districts of Uttar Pradesh, India.Methods: A community-based cross-sectional survey was conducted between June-October 2018 in the rural areas of 25 high priority districts of Uttar Pradesh, India. Simple random sampling was used to select 40 blocks among 294 blocks in 25 districts and 2646 primary sampling units within the selected blocks. The survey interviewed 9458 women who had a delivery 2 months prior to the survey. Descriptive statistics were included to characterize the study population. Multivariable logistic regression analyses were performed to identify the determinants of birth preparedness and to examine the association of birth preparedness with institutional delivery.Results: Among the 9458 respondents, 61.8% had birth preparedness (both facility and transportation identified) and 79.1% delivered in a health facility. Women in other caste category (aOR = 1.24, CI 1.06-1.45) and those with 10 or more years of education (aOR = 1.68, CI 1.46-1.92) were more likely to have birth preparedness. Antenatal care (ANC) service uptake related factors like early registration for ANC (aOR = 1.14, CI 1.04-1.25) and three or more front line worker contacts (aOR = 1.61, CI 1.46-1.79) were also found to be significantly associated with birth preparedness. The adjusted multivariate model showed that those who identified both facility and transport were seven times more likely to undergo delivery in a health facility (aOR = 7.00, CI 6.07-8.08).Conclusion: The results indicate the need for focussing on marginalized groups for improving birth preparedness. Increasing ANC registration in the first trimester of pregnancy, improving frontline worker contact, and optimum utilization of antenatal care check-ups for effective counselling on birth preparedness along with system level improvements could improve birth preparedness and consequently institutional delivery rates in Uttar Pradesh, India. [ABSTRACT FROM AUTHOR]

Background: According to WHO, 536,000 women die every year in the world from causes relating to pregnancy, childbirth, or postpartum. Ninety nine percent of these deaths occur in the developing countries. Primary health centres (in densely populated areas and in urban slums are also referred to as family welfare centres, since they provide the whole continuum of care, from birth through adolescent and delivery and thereafter. Aim: To evaluate the antenatal services under Reproductive, Maternal, Newborn, Child plus Adolescent (RMNCHA) programme at a family welfare centre located in Central Delhi, India. We have proposed an action plan that will help in evaluating and improving these services. Methodology: The study included health providers of antenatal services and the beneficiaries. With a response rate of 90% from a sample of 218, 203 consenting antenatal women (beneficiaries) visiting the centre for ANC check-up under RMNCH + A programme and PMSMA were included. For quantitative component, a pre-designed, pre-tested semi-structured screening questionnaire were administered to the beneficiaries and healthcare providers to evaluate the antenatal services under RMNCH + A programme at the family welfare centre. Results: Qualitative and quantitative analysis was done separately. Only 43% of ANC women said health workers visited them at home during pregnancy and very few could tell about importance of lab investigations. Almost all (97%) knew about key messages given by health workers. Nearly all participants considered that the screening process was smooth. The waiting time and time to undergo varied from 4 to 6 min. [ABSTRACT FROM AUTHOR]

Background: High-risk pregnancy (HRP) puts current pregnancy at an increased risk of complications. In the absence of pre-existing HRP implementation model of the country, in collaboration with the Government of Himachal Pradesh, a new digital HRP model called the 'SEWA—A System E-approach for Women at risk' was developed. The current article demonstrates a model for the early identification and line listing of high-risk pregnant women (PW) with appropriate referrals and increased engagement with the healthcare workers using a digital tool in the form of the Android App. Methods: SEWA was implemented as a pilot intervention in two community development blocks of the Chamba district. The key implementation steps included finalizing protocols for the identification of HRPs, defining processes and roles, mapping health facilities, setting up the communication loop, and developing of digital solutions. The digital app, used by the auxiliary nurse midwife (ANM) and program officers, tracked PW for a year from October 19 to October 20 and recorded the ANC visits, referrals, and birth outcomes. A qualitative assessment was conducted among the health workers to find out their level of acceptance. Results: A total of 1,340 high-risk PW were identified. The intervention year saw a rise in the identification of HRP to 27.9% from 3.5% in the previous year. A total of 2,559 conditions were tagged to the identified 1,340 women categorized into current pregnancy (81%), previous pregnancy (16%), and any existing chronic illness (3%). A majority of the women who required urgent referrals were provided referrals. The application recorded 53% of the delivered HRP with a digital birth preparedness plan, prepared and shared with the PW and Accredited Social Health Activists (ASHA), by text message for compliance. Conclusion: The SEWA application is a feasible and sustainable solution to complement the competency of the care providers for early identification of the high-risk conditions and reduce the burden of preventable unprecedented deaths around the time of birth. [ABSTRACT FROM AUTHOR]

Background: As a mitigation measure for COVID-19 pandemic, lockdown was implemented in India for a period of 2 months (24 March-31 May 2020). Disruption in antenatal care (ANC) provisions during lockdown is expected due to diversion of public health facilities on pandemic.Objective: To assess the proportion of pregnant women who had not completed the ideal number of antenatal visits, availability of iron-folic acid (IFA) supplements and challenges in availing health services during the period of lockdown.Methods: A concurrent mixed-methods study was conducted among pregnant women in Puducherry, India. Information on obstetric characteristics and details regarding antenatal visits were collected through telephonic interviews. In-depth interviews were conducted to understand the perceived challenges in availing health services during the lockdown period.Results: Out of 150 pregnant women, 62 [41.3%; 95% confidence interval (CI) 33.6-49.3] did not complete the ideal number of visits and 61 (40.7%, 95% CI 32.7-49.0) developed health problems. Out of 44 women who received medical care for health problems, 11 (25%) used teleconsultation. Of all the women, 13 (8.7%, 95% CI 4.9-14.0) had not taken the IFA supplements as prescribed by the health provider. Economic hardship, restricted mobility, lack of information about the health system changes and psychological stress due to the fear of COVID were the challenges in accessing care.Conclusions: Two out of five pregnant women did not complete the ideal number of visits and developed health problems during the lockdown period. [ABSTRACT FROM AUTHOR]

Background: In India mother related mortalities and morbidities are still significantly higher even after having various maternal program and schemes at regional and national level which reflects that such services are being under-utilized. Aim: The current study focused in assessing utilization pattern of maternal health services and associated factors in Nuh (Mewat). Methods: This present cross-sectional study was done for one year (2015-16) among mothers (15-49 years) under field practice area, PHC Taoru with minimum calculated sample as 645. The selection of participants was made using simple random sampling technique from available randomized list of villages. Data was collected by home-to-home visits using pretested, predesigned, standardized questionnaire and during analysis an association between variables was considered as significant if P < 0.05. Results: Out of 645 participants, 632 provided consent for inclusion into study. Any ANC and full ANC services was made by only 58.3% and 11.7% of participants respectively. More than half of the participants (52.7%) had suffered from pregnancy related complications. Variables such as lower age group, low decision-making capacity were significantly associated with not obtaining full ANC services (P < 0.05). Conclusion: In the present study major determinants of a women which influence utilization of maternal health care service includes their age, literacy status, parity, socioeconomic status and occupation. Such determinants shall be considered for upcoming intervention aiming to bring attitudinal changes and concurrently leading to improved and enhanced usage of maternal health care services. [ABSTRACT FROM AUTHOR]

Background: Poor Maternal and Child Health (MCH) outcomes pose challenges to India's ability to attain Goal-3 of the Sustainable Development Goals (SDGs). The government of India strengthened the existing network of frontline health workers (FHWs), under its National Rural Health Mission in 2005 and subsequent National Urban Health Mission in 2013 as a strategy to mitigate the shortage of skilled health workers and to provide affordable healthcare services. However, there is a lack of robust national-level empirical analysis on the role of maternal engagement with FHWs in influencing the level of maternal and child health care utilisation and child health outcomes in India.Methods: Using data from the nationally representative Indian National Family Health Survey (NFHS) 2015-2016, this paper aims to investigate the intensity of engagement of FHWs with married women of child-bearing age (15-49 years), its influence on utilisation of maternal and child healthcare services, and child health outcomes. Our empirical analyses use multivariate regression analyses, focusing on five maternal and child health indicators: antenatal care visits (ANC) (4 or > 4 times), institutional delivery, full-immunisation of children, postnatal care (PNC) (within 2 days of delivery), and child survival.Results: Our analysis finds that maternal engagement with FHWs is statistically significant and a positive predictor of maternal and child health care utilisation, and child survival. Further, the level of engagement with FHWs is particularly important for women from economically poor households. Our robustness checks across sub-samples of women who delivered only in public health institutions and those from rural areas provides an additional confidence in our main results.Conclusions: From a policy perspective, our findings highlight that strengthening the network of FHWs in the areas where they are in shortage which can help in further improving the utilisation of maternal and child healthcare services, and health outcomes. Also, the role of FHWs in the government health system needs to be enhanced by improving skills, working environment, and greater financial incentives. [ABSTRACT FROM AUTHOR]

Introduction: Maternal mortality still remains a major public health challenge in India. Delays in seeking, reaching and obtaining to appropriate intranatal care are the crucial factors determining maternal mortality. Birth Preparedness and Complication Readiness (BPACR) is the process of planning for normal birth and anticipating the actions needed in case of an emergency. It is a logical process of addressing delays in delivery. Aim: To assess BPACR status of postnatal mothers using BPACR index and to determine association between socio demographic and other variables and BPACR status among them. Materials and Methods: The cross-sectional, observational study was conducted on 200 post-natal mothers of Indoor Patient Department (IPD), Department of Gynaecology and Obstetrics, in a tertiary care hospital in West Bengal. Socio demographic information and information on antenatal history, decision makers during pregnancy, type and distance of nearest health facility, knowledge of danger signs, identification of the skilled birth attendant, mode of transport, arrangement for money and other variables were collected by interviewing the patients with a predesigned, pretested, semi structured schedule and by reviewing records. BPACR is the process of planning for normal birth and anticipated actions needed during an emergency. To assess BPACR status among postnatal women, BPACR index is measured which consists of a set of indicators. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Proportion and chi-square test were used wherever applicable. The p-value of less The p-value of less than 0.05 was taken as statistically significant. Results: The final BPACR index was 61.07. All participants identified skilled birth attendants for delivery. Almost all were aware of Janani Suraksha Yojana (JSY). Among 200 women, about 90% of them had knowledge about transportation services provided by the government. Only 63.5% of the mothers (127/200) availed Antenatal Care (ANC) by skilled provider. About 38.5% (77/200) of study participants identified the mode of transportation, and 38% (76/200) of them saved money for delivery expenses. No participant could identify more than eight danger signs of pregnancy. Overall, 75% (150/200) of participants were well prepared. On bivariate analysis, good preparedness have been found to be significantly associated (p-value <0.05) with age group, type of decision maker during pregnancy and presence of the husband accompanying their wives in any of the ANC visits. Conclusion: Majority of the population were well prepared, but awareness on danger signs was very low. Women empowerment in terms of behavior change communication at family, community and tertiary care level to be carried out through formal and informal approaches are the needs of the hour. [ABSTRACT FROM AUTHOR]

Background: Maternal deaths among young women (15-24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper, therefore, aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India.Methods: The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992-93, 1998-99, 2005-06 and 2015-16. Young married women aged 15-24 years with at least one live birth in the 3 years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. The significance level for all analyses was set at p ≤ 0.05.Results: The use of full ANC among young mothers increased from 27 to 46% in India, and from 9 to 28% in EAG (Empowered Action Group) states during 1992-2016. SBA utilization was 88 and 83% during 2015-16 by showing an increment of 20 and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed a significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time.Conclusions: In India coverage of full ANC among young mothers remained unacceptably low, with a wide and persistent gap in utilization between EAG and non-EAG states since 1992. Targeted health policies should be designed to address low coverage of ANC and SBA among underprivileged young mothers and increased efforts should be made to ensure effective implementation of ongoing programs, especially in EAG states. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to understand the complex relationship between maternal complications and women's characteristics in India. Methods: The present study builds structural equation modeling (SEM) using the data from the National Family Health Survey round 4 (2015–16) and includes 190, 898 women who had given their last birth during 5 years preceding the survey. Based on eight questions related to maternal complications, the SEM constructed two latent variables – complications during pregnancy (PREGCOMP) and delivery (DELCOMP). Results: Result shows that prolonged labor was highly prevalent (42%) among women, followed by vaginal bleeding (34%) and swelling in legs, body or face (32%). Women from affluent households (β = −0.02 for each‐middle, richer and richest quantile), with higher education (β = −0.02), timing when they received first ANC (β = −0.003) and women who received full ANC (β = −0.01) had a lower risk of PREGCOMP. However, consanguineous marriage (β = 0.01) was positively related to PREGCOMP. Further, women with PREGCOMP (β = 0.20), rural residents (β = 0.02), having exposure to mass media (β = 0.01), and who had facility delivery (β = 0.04) were at high risk of DELCOMP. Women with pregnancy complications are more likely to have delivery complications. [Correction added on 27 November, after first online publication: The statement "who received full antenatal care (ANC) (β = −0.05)" has been removed.] Conclusion: Socioeconomic and demographic factors significantly affect both the latent variables. This study concludes that the use of intensive healthcare services reduces health complications. The paper recommends early visits and full ANC checkups to reduce pregnancy complications. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic has brought about a paramount change in the life. This has lead to a reduction in the number of routine patients visiting the Outpatient Department (OPD) of various hospitals and this department was no exception. Aim: To compare the attendance of patient in Antenatal Care (ANC) and Gynaecology Out Patient Department (GOPD) between pre-lockdown and lockdown period due to Covid-19 pandemic. Materials and Methods: The study was conducted among patients attending the OPD in ANC and Gynaecology for 70 days lockdown from 23rd March to 31st May and 70 days immediate pre-lockdown period from 12th January to 22nd March 2020. Daily attendance was noted and types of patient attending in different sub clinics in Gynaecology OPD compared. Enrolment of new ANC patient and old booked cases was compared during both periods. Descriptive statistics were used and displayed as percentages. Results: There was a significant reduction in number of patients attending OPD in lockdown period. There was a total of 6088 (87.3%) reduction in number of patients in Gynaecology OPD and 2235 (69.6%) reduction of patients in ANC OPD which was found to be significant with p-value<0.001. Reduction of patient in lockdown days among new ANC was 574 while it was 1661 in case of old patients. The different sub clinics of GOPD like infertility (704), endocrine (1450), uro-gynaecology (656), STD/ PID (732), postpartum (597), cancer detection (316), abortion and medical termination of pregnancy (MTP) (330), others (1303) also witnessed a diminution of attendance. Conclusion: COVID-19 caused a significant decrease in footfall of patients in outpatient department due to lockdown, though the percentage of types of patient attending Gynaecology OPD was almost same. [ABSTRACT FROM AUTHOR]

Worl dover the most important yardstick for the countrys progress and prosperity is the Maternal Mortality Ratio and Infant Mortality Rate. Every year countries make a concreted efforts to better their figures and a most important aspect is the utilization of the maternal and neonatal services. Maternal health services have a very important bearing on the Maternal and Infant mortality rate and the prevailing socio economic and services offered are an important determining influences. Various studies in India have concluded socio-economic factors and service delivery environment as important determinants influencing maternal health services. Use of ANC increases the likelihood of skilled attendance at delivery, which later increases the use of postnatal care. To determine the factors influencing the Antenatal Care services. To assess the antenatal care services and socio-demographic factors affecting ANC services in rural areas of Lucknow. It was a community based Cross sectional study . This study was conducted for a period of 3 months, from July 2014 to September 2014. Sample Size: a total of 100 RDW were included in the study. Multistage random sampling technique was used to select 100 RDW .Information was collected on Age, Religion, Caste, Educational status of RDW, Type of Family and Socioeconomic class, ANC registration, Number of ANC visits, Number of TT Injection received, IFA received and consumed, Antenatal check up etc. 56% of RDW, belong to age group 18-25, years.Majority of RDW were Hindu(61%).60% of RDW had Nuclear type of family, most of the RDW (60%) belonged to class IV. Amongst these 48% RDW had three antenatal visits, where as 41% had more than three antenatal visits.100 % of RDW had government health facility as a place of ANC registration. no statically significant association was observed between the religion of RDW,and antenatal visits/IFA tablet consumption.(p>.05).Variables such as,socioeconomic status and educational status of RDW, were not significantly associated with either antenatal visits or IFA tablets,(p>.05) for all. In this study Antenatal care services were received by majority of RDW . The Utilization of ANC services was encouraging in the study area. Counseling on antenatal care is one of the main component of MCH services, but it was found to be lagging with respect to following components of antenatal care like birth preparedness and safe delivery, personal hygiene, rest, nutrition and management of ANC complications. [ABSTRACT FROM AUTHOR]

Introduction: The world's second most populous country-India, witnesses 20-30% pregnancies that belong to the high-risk category out of the total pregnancies in the country. 12% of the global maternal deaths are attributed to India. The Rural areas of the country are further vulnerable to high maternal and infant mortality rates due to a rural-urban divide and unavailability of health resources. Objectives: The rationale of this paper is to understand and illustrate common High Risk Pregnancies (HRPs) in the rural area of Shorapur and to gauge the preparedness of the health facility in the area to help deliver safe child birth for the mother and the child. Materials and Methods: A cross-sectional study was conducted in pregnant women attending the Antenatal Care (ANC) clinic in sub-district hospital of northern Karnataka over a period of 03 months. Results: A total of 601 high risk conditions were identified in ANC women. Of the total ANC women with HRP 44.1% (n= 265) had previous Caesarean Section, 15.1% (n=91) had RH incompatibility, 12.6% (n=76) were observed to be Short Primi, 9.7% (n= 58) experienced Bad Obstetric History/Antepartum Haemorrhage, 8.2%% (n=49) had Gestational Hypertension, 5.8%% (n=35), were severely Anaemic, 4.2% (n= 25) had Multiple pregnancy and the remaining 0.3% (n=3) had tumour, Gestational DM and Rheumatoid Arthritis. Discussion: As per the observed HRPs and respective health facility preparedness, two main barriers to safe pregnancy and childbirth emanated during the study - inadequate infrastructure and services for blood transfusion, dearth of trained health professionals. Conclusion: Direct referral of high risk cases to appropriate facilities that have the required capacity to support such cases must be made. Tele-medicine can be considered as an efficient alternative to connect the ANC women with the specialist doctor remotely for evaluation of HRPs. A blood storage unit must be established in all SDH hospitals as a minimum requirement. [ABSTRACT FROM AUTHOR]

Background: The HIV sentinel surveillance (HSS) serves to estimate the levels and trend of HIV prevalence among high-risk, bridge, and general population and monitors HIV management at national, state, and district levels. Data from HSS are valuable in understanding the risk factors associated with HIV transmission with particular demographic characteristics. Objectives: The objective was to analyze the sociodemographic profile of the pregnant mothers attending the antenatal care (ANC) clinics in Karnataka, in order to understand the dynamics of HIV within the general population in Karnataka. Materials and Methods: Study design: this was a cross-sectional study conducted using consecutive sampling method. Study setting: the surveillance was conducted at select antenatal clinics, in Karnataka, India, between January and March, in the years 2013, 2015, and 2017. Methodology: in total, 74,278 eligible pregnant women aged between 15 and 49 years, attending the sentinel sites for the first time during the surveillance period, were included in the study. Information on their sociodemographic characteristics and blood samples was collected. Results: HIV prevalence among the ANC clinic attendees has significantly declined, reaching a recent stabilization. The risk factors significantly associated with HIV among pregnant women were age, education, occupation, and marital status. HIV is highly concentrated in the northern and southern districts of Karnataka. Conclusion: Despite the declining trends of HIV prevalence in Karnataka, the epidemic is heterogeneous and concentrated within the state, calling for decentralized region-specific interventions. [ABSTRACT FROM AUTHOR]

Background: The postchildbirth period presents considerable challenges in the form of health risks for the mother and the newborn, yet postnatal care (PNC) remains seldom utilized maternal and newborn health intervention. Objectives: The present study aims to study the coverage of PNC among rural women in Punjab and understand the factors that determine the utilization of PNC services. Materials and Methods: From rural areas of seven districts of Punjab, a total of 420 respondents were questioned using semi-structured interview schedule. Binary logistic regression is employed to understand the factors that influence the utilization of complete PNC. Results: The utilization of complete PNC has remained mere 25.9% in the present study. The results of multivariate logistic regression reveal that variables district, caste, birth order, and type of delivery significantly influence the utilization of complete PNC. Conclusion: The utilization of PNC component is found to be abysmal as compared to antenatal component and institutional delivery among the study group. There is a need to create awareness regarding the necessity of PNC among the women. [ABSTRACT FROM AUTHOR]

Objectives: LBW is the strong determinant of neonatal morbidity and mortality with a global prevalence of nearly 15%. India's prevalence, though not yet established, ranges from 16-30% and influenced by maternal nutritional status, antenatal care and associated maternal morbidity. Hence, the study was aimed to determine the influencing parameters for occurrence of LBW. Study Design: A retrospective observational study conducted for all live newborns delivered in a tertiary care centre during the study period of twenty four months. Methods: Data from institutional medical record section was recorded on predesigned questionnaire from a total of 1216 newborns. Results: The percentage of LBW was found to be 27.55% (335/1216) with a proportion of LBW to NBW babies was approximately 1:3. The occurrence of LBW was significantly higher in babies of anemic mothers (59.39%, P < 0.0001), young mothers (30.39%, P < 0.01), mothers with parity ≥ 3 (35.71%, P < 0.05), those with <3 ANC check-up (56.88%, P < 0.0001) and those with premature delivery (71.57%, P < 0.0001). Maternal anemia (OR 4.7, 95%CI 3.4-6.7, P < 0.001); ANC with <3 visits (OR 2.2, 95%CI 1.4-3.4, P < 0.01) and prematurity (OR 7.6, 95%CI 5.1-11.2, P < 0.0001) were considered as independent risk factor for LBW. Significant association of neonatal complications was found with LBW babies (OR 1.6, 95%CI 1.1-2.5, P < 0.05). Conclusions: Inadequate antenatal care, maternal anemia and other maternal illness causing premature delivery are considered critical determinants for LBW and thus associated with high neonatal mortality and morbidity. Continued focus for improving the overall maternal health status would lead to lowering burden of LBW. [ABSTRACT FROM AUTHOR]

Background: The prevalence of low birth weight (LBW) has remained high (24.9%) in the South Asian region with a significant impact on newborn survival. This region bears nearly 40% of global burden of LBW. While antenatal care (ANC) and iron-folic acid supplementation independently have been considered effective for improving maternal and newborn outcomes, the evidence on the combined effect of these two supplements on LBW is lacking. This study aimed to examine the synergistic association of ANC and iron-folic acid supplementation on LBW in the South Asian region using pooled data from six South Asian countries., Methods: Nationally representative surveys from Nepal, India, Bangladesh, Pakistan, Maldives, and Afghanistan were included in the study. Birth weight and the prevalence of LBW for singleton last-born children were reported using descriptive statistics. The association between LBW and ANC visits and the interaction between iron-folic acid consumption and ANC were examined using multiple logistic regression., Results: The mean birth weight in the region was 2841.8 g with an LBW prevalence of 17.1%. Country-specific prevalence ranged from 11.4% in Nepal to 22.4% in Pakistan. Not attending ANC visits (adjusted odds ratio (AOR): 1.24; 95% confidence interval (CI): 1.16, 1.34) and not consuming iron-folic acid (AOR: 1.14; 95% CI: 1.08, 1.21) were significantly associated with a higher likelihood of LBW. Furthermore, jointly, having < 4 ANC visits and < 180 days of iron-folic acid supplementation was associated with a higher likelihood (AOR: 1.29; 95% CI: 1.22, 1.36) of having LBW compared to those who had  ≥ 4 ANC visits and ≥ 180 days of iron-folic acid consumption after controlling for key confounding factors., Conclusions: The current study provides important evidence on the synergy between ANC visits and iron-folic acid consumption during pregnancy to capitalize on the existing national maternal health programs in the South Asian region, including low-and middle-income countries for positive foetal outcomes., (© 2024. The Author(s).)

Background: COVID-19 outbreak was declared as a global pandemic. India decided to lock down the country bringing hardships to her people. Objective: To study the challenges met by a pregnant woman during the COVID-19 pandemic and lockdown in India. Material and Methods: Consenting pregnant women were given questionnaire to answer. Results: 32.1%were primigravida and 67.9% were multigravida. 66.42% said that they feared they either themselves or their baby could contract COVID-19 disease.46.5% of the participants did not take antenatal visit to the doctor. The reasons given were, they followed the government advisory not to visit hospitals unnecessarily (26%), non-availability of transport (39.7%), fear of coming to the hospital (22.3%).237.26% took teleconsultation and 79.2% were satisfied with the response. 18.45% took medications from the pharmacy on their own and 52.52% did not receive their due tetanus toxoid injection.44.46% could not get their due obstetric ultrasonogram. Conclusion- Abrupt lockdown of the country not only prevented the spread of the virus, but also brought about hardships to pregnant women 19 Pandemic affected the antenatal care of pregnant women. [ABSTRACT FROM AUTHOR]

Background: India has focused on incentivizing institutional delivery and introducing the ASHA worker as a key strategy to improve maternal health outcomes. We examined the determinants of institutional delivery and the role of the ASHA worker in shaping choice regarding place of delivery.Methods: We used data from the India Human Development Survey-II conducted in 2011-12, and extracted an analytic sample of women (N = 8711) who reported having at least one child since 2005. Logistic regression was used to examine influence of socio-demographic factors, frequency of antenatal care (ANC) contacts and exposure to ASHA worker on institutional delivery.Results: About 15% of the respondents had eight or more ANC contacts. The odds of having an institutional delivery were higher among those respondents who had 8 or more ANC contacts (OR = 3.39, p < 0.001, 95% CI: 2.26, 5.08), and those who had 4-7 ANC contacts (OR = 1.72, p < 0.001, 95% CI: 1.48, 1.99) as compared to those with less than 4 ANC contacts. About 26% of the respondents had any exposure to an ASHA worker. After controlling for ANC contacts, these respondents had three times the odds of institutional delivery (OR = 3.04, p < 0.001, 95% CI: 2.37, 3.89) compared to those who had no exposure to ASHA workers. Further, several sociodemographic variables were associated with institutional delivery. While age of spouse, age at marriage, level of education and urban residence were positively associated with institutional delivery; age of respondent and number of children were inversely associated with institutional delivery.Conclusions: Both frequency of ANC contacts and exposure to ASHA worker independently emerge as important determinants of institutional delivery. Furthermore, ASHA workers may have a crucial role in promoting antenatal care, thereby strengthening the association between ANC contacts and institutional delivery. [ABSTRACT FROM AUTHOR]

Objective: To investigate the temporal trend of socioeconomic and rural-urban disparities and geographical variation in the utilization of antenatal care (ANC) services in India before and throughout the Millennium Development Goals era.Data Sources/study Setting: For this temporal analysis, secondary data from the Indian National Family Health Surveys between 1998 and 2015 (Waves 2, 3, and 4) were used.Study Design: We analyzed the trend in inequality for at least one and four ANC visits to a health care professional (ANC1+ and ANC4+, respectively) by education, wealth, and residence type. Multilevel logistic regression models were used to assess the temporal trend and the relative contribution of communities and states to the overall variation in ANC1+ and ANC4+.Data Collection/extraction Methods: Data on utilization of ANC services for the last birth of women aged 15-49 years during the three or five years preceding the survey (depending on the survey year) were used.Principal Findings: Educational and wealth inequality in ANC1+ and ANC4+ worsened between 1998 and 2005 and improved between 2005 and 2015 (for ANC4+, OR [95% CI] = 0.22 [0.19-0.25] in Wave 2; OR [95% CI] = 0.19 [0.17-0.22] in Wave 3; and OR [95% CI] = 0.38 [0.36-0.40] in Wave 4 for the poorest). Rural-urban inequality showed a consistent decline (for ANC4+, OR [95% CI] = 0.59 [0.54-0.64] in Wave 2; OR [95% CI] = 0.63 [0.59-0.68] in Wave 3; and OR [95% CI] = 0.82 [0.79-0.85] in Wave 4 for rural area). The relative contribution of the community to the total geographic variation in the utilization of ANC services increased more than four times during the study period.Conclusions: The use of ANC services remains disproportionately lower among women with low socioeconomic status. Efforts to directly target these women are necessary to tackle inequality in ANC utilization in India. [ABSTRACT FROM AUTHOR]