Postnatal Care Utilisation Among Adolescent Mothers in India: A Pooled Cross-Sectional Study of NFHS-4 and NFHS-5

Although postnatal care (PNC) is a critical component of maternal health services, empirical evidence on its utilisation and associated factors among adolescent mothers in India remains limited. Using nationally representative data from the fourth (2015-16) and fifth (2019-21) rounds of the National Family Health Survey, this study examines trends and determinants of PNC utilisation among mothers aged 15-19 years. PNC within 42 days of delivery was analysed as a binary outcome using multivariable logistic regression. PNC utilisation among adolescent mothers increased substantially between the two survey rounds, from 69.9% in 2015-16 to 82.3% in 2019-21. Despite this progress, marked socio-economic and regional inequalities persisted. By 2019-21, the lowest utilisation was concentrated in the north-eastern region, particularly in Nagaland (47.1%), Mizoram (64.7%), Assam (69.3%), and Arunachal Pradesh (69.7%). Multivariable regression analysis showed that PNC utilisation was most strongly associated with place of delivery and antenatal care attendance, with a clear dose-response relationship for the number of antenatal care visits. Adolescent mothers delivering in health facilities and those receiving eight or more antenatal care visits were significantly more likely to utilise PNC. Household wealth, health insurance coverage, and region of residence were also significant predictors. Although India has made substantial progress in antenatal care and institutional delivery, PNC utilisation among adolescent mothers remains uneven. Improving continuity between antenatal care, delivery services and postnatal follow-up, and addressing persistent socio-economic and regional inequalities, is important for ensuring equitable access to PNC.