National improvements in quality of prenatal healthcare across states and territories in India from 2006 to 2021: a systematic analysis

AimThis study aimed to assess changes in India's prevalence of low birth weight (LBW) infants relating to the quality of prenatal healthcare, coverage of the Integrated Child Development Services Scheme (ICDS) and maternal factors from 2006 to 2021.Subject and methodsData from India's demographic health survey (DHS) were analysed at three times points - 2006, 2016 and 2021. States were classified as 'low healthcare spending and resource (HSR)' or 'high HSR'. Chi-square analysis was conducted to identify differences between quality of prenatal healthcare, coverage of pregnancy benefits, prevalence of LBW infants and changes in maternal factors across three time points and between low HSR and high HSR states. Factor analysis was subsequently used to devise a quality of pregnancy healthcare index, while multi-level analysis was conducted to identify the influence of quality of pregnancy healthcare on LBW and the influence of adolescent pregnancies on quality of prenatal healthcare at both individual and state levels.ResultsA significant reduction in LBW infants was found from 2006 to 2021, while significant improvements in quality of prenatal healthcare, coverage of ICDS pregnancy benefits and maternal factors were identified. Significantly poorer quality of pregnancy health was consistently identified across low HSR states, with mothers reporting having received fewer aspects of standard and advanced prenatal care. Prevalence of adolescent (under 20 years) pregnancies remained above 30%, and adolescent pregnancies significantly predicted worse scores in quality of prenatal care.ConclusionSignificant disparity in quality of prenatal healthcare is still evident between low and high HSR states. Adolescent pregnancies also remain as a critical issue that needs to be addressed in India, predicting poor access to prenatal healthcare, yielding a lower score on standard and advanced prenatal care subscales. Further government and community-based efforts are required to bridge the gap in the accessibility and quality of prenatal care between low HSR and high states in India.