Spatial inequalities in quality antenatal care in India: a district-level analysis
Rahul Nandan1, Ashutosh Kumar2, Uttara Singh1
1University of Allahabad CMP Degree College, Prayagraj, India.
Frontiers in Public Health
|August 1, 2026
Summary
Quality antenatal care (Q-ANC) use in India shows significant regional disparities, with southern areas performing better. Determinants of Q-ANC utilization vary spatially, necessitating targeted interventions for equitable maternal healthcare access.
Area of Science:
- Public Health
- Spatial Epidemiology
- Health Services Research
Background:
- Quality antenatal care (Q-ANC) is crucial for maternal and child health outcomes.
- Significant regional inequalities in Q-ANC utilization persist across India.
- Understanding spatial patterns and determinants is key to improving maternal healthcare access.
Purpose of the Study:
- To analyze the spatial distribution and determinants of Q-ANC utilization in Indian districts.
- To identify geographic clustering and spatial heterogeneity in factors influencing Q-ANC uptake.
- To inform geographically targeted policy interventions for equitable maternal healthcare.
Main Methods:
- Utilized National Family Health Survey (NFHS-5) data (2019-21) for district-level analysis.
- Employed spatial statistical techniques: Global and Local Moran's I, spatial regression, and Geographically Weighted Regression (GWR).
- Operationalized Q-ANC as receiving at least five of seven essential antenatal care components.
Main Results:
- Substantial regional disparities observed, with higher Q-ANC coverage in southern India and lower in northern/northeastern regions.
- Significant positive spatial autocorrelation (Moran's I ≈ 0.60, p < 0.001) confirmed strong geographic clustering.
- Key determinants include intended pregnancy, mass media exposure (positive association), and higher parity, disadvantaged populations (negative association).
- GWR revealed significant spatial variation in these determinants, explaining up to 80% of the variation.
Conclusions:
- Determinants of maternal healthcare utilization are not uniform across space.
- Localized socio-demographic and health system factors significantly shape Q-ANC access and quality.
- Geographically targeted interventions are essential to address regional inequalities in maternal healthcare in India.
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