Utilization of full antenatal care among Scheduled Caste mothers in India, 2015-2021.

Background: Despite the well-documented benefits of full ANC- which includes at least four visits starting in the first trimester, two or more tetanus shots, and over 100 days of iron-folic acid (IFA) supplementation coverage remains alarmingly low, particularly among socioeconomically disadvantaged Scheduled Caste (SC) mothers. However, there is a dearth of research focusing specifically on this population. Therefore, this study aims to investigate the change in the coverage of full ANC and its determinants among SC mothers in India.

Methods: Using data from the two latest rounds of the National Family Health Survey (2015-16 and 2019-21), a pooled sample of 51,705 SC mothers was analysed. Bivariate statistics was used to assess the significance of association between full ANC utilisation and the independent characteristics. Furthermore, to investigates the net effect of the predictor variables on the receipt of full ANC, multivariable binary logistic regression was applied.

Results: The coverage of full ANC in India increased from 20.7% in 2015-16 to 26.9% in 2019-21. While there were substantial gains in the coverage of ANC within the 1st trimester (68.4-74.8%) and IFA (39.1-48.6%), the coverage of two or more tetanus toxoid injections (87.1-85.2%) and 4 or more ANC visits (63.6-62.4%) registered a slight decline. Among the states, West Bengal (16.4% in NFHS-4 to 45.1% in NFHS-5) experienced the largest gain, while Gujarat had the lowest increase, 41.2% in NFHS-4 to 40.9% in NFHS-5. In South India, Kerala (59.9-75.4%) and Tamil Nadu (35.8-56.1%) saw substantial increases of 15-20 percentage points (PP), whereas Karnataka and Andhra Pradesh experienced marginal declines of 1-3PP. Rajasthan (10.0-21.0%), Madhya Pradesh (11.3-27.2%), Uttarakhand (8.7-21.4%), and Odisha (18.7-40.1%) witnessed substantial gains of 11-22 PP, while Bihar, Uttar Pradesh, Jharkhand, and Chhattisgarh had more modest increases of 1-5 PP. Mothers aged 40-44 years (Adjusted Odds Ratio: 2.18, 95% CI: 1.61-2.95), those with higher education (1.64, 1.44-1.87), and those from rich households (1.49, 1.34-1.66) were significantly more likely to receive full ANC compared to women aged 15-19 years, those with no education, and those from poor households, respectively. Similarly, women residing in the southern region (2.19, 1.99-2.41) and those with high exposure to mass media (1.53, 1.38-1.69) were more likely to receive full ANC compared to women residing in the northern region and those with no exposure to mass media, respectively. Conversely, multiparous mothers (0.57, 0.52-0.63) and women residing in rural areas (0.88, 0.81-0.95) were less likely to receive full ANC compared to women with only one parity and those residing in urban areas, respectively.

Conclusions: While national coverage of full ANC has improved, significant gaps remain, particularly in states in northern, central, and northeastern India. To achieve equitable coverage, it is crucial to prioritize vulnerable groups within the SC community, such as young, impoverished, uneducated, and rural mothers. Additionally, leveraging mass media campaigns and strengthening the role of frontline healthcare workers could be effective strategies to enhance full ANC utilization among SC mothers.