Women's healthcare access: assessing the household, logistic and facility-level barriers in India

Ensuring comprehensive and quality healthcare access is necessary to promote good health and well-being and to secure health equity. Barriers to healthcare access result in unmet health needs. Moreover, there is limited empirical evidence on specific types of barriers to women's general health-seeking in India. This study investigates women's perceived household-level, logistic, and facility-level barriers to healthcare access and its individual, household, and community-level determinants.

The study used data from the fifth round of the National Family Health Survey (NFHS-5), with a total sample of 108,785 women aged 15-49 drawn from the state module of the survey. The primary outcome variables were household, logistic, and facility-level barriers to healthcare access. A set of individual, household, and community-level predictors was assessed using multivariate binary logistic regression due to the dichotomous nature of the outcome variables. The adjusted odds ratio (AOR) with the corresponding 95% confidence intervals (CI) was used to present the regression results. The Hosmer-Lemeshow test and ROC curve statistics were carried out to enhance the robustness of the analysis and validity of the model.

The study found a considerable proportion of women (84%) with at least one perceived barrier to accessing healthcare, with significant inter-state variations. Facility-level (55%) and logistic barriers (51%) were the predominant obstacles to healthcare access. Women aged 35-49, with higher education levels, exposed to mass media, working in professional/technical/managerial/clerical jobs, access to bank accounts, having mobile phones, and from rich households had lower odds of perceived household, logistic, and facility-level barriers to healthcare access.

Most women perceive barriers to healthcare access, though a wide inter-state variation exists. Facility-level barriers such as the unavailability of drugs and healthcare providers are major concerns to healthcare access. Distance to health facilities continues to be a logistic barrier, along with getting money for treatment at the household level. Illiteracy, non-exposure to mass media, working in the agricultural sector, no access to a bank account and a mobile phone, rural residency, and poor wealth status are significant factors adversely affecting the perceived barriers to healthcare access. The findings recommend strengthening the existing health system and increasing health literacy among poor, less educated, and rural women to reduce disparity in healthcare access.