Abstract
BackgroundIndia, 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?MethodsThe 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.ResultsNearly 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.ConclusionThe 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.
Highlights
India, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity
Out of those women who had institutional delivery along with 4 + anFtenatal care (ANC) visits, about 48% had gone for Postnatal care (PNC) with a loss of 14% at third level
Only 39% had completed continuum of care (CoC), who were defined as the women who received adequate ANC, institutional delivery (ID), PNC and taken their children for full immunization
Summary
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. What are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India?. Accelerating progress earlier towards Millennium Development Goals and towards Sustainable Development Goals to improve the maternal, newborn and Kothavale and Meher BMC Pregnancy Childbirth (2021) 21:731 child health (MNCH) has achieved high importance on the global agenda [1]. Major investments made by the global community over the past decade have resulted in impressive achievements in reducing maternal, neonatal, and child mortality [2]. In 2019, about 2.4 million newborns died worldwide, and around 1.9 million babies were stillborn [3]
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