Utilisation of Maternal and Child Healthcare Services across the Continuum of Care and Its Determinants in Nuh District, Haryana, India: Evidence from National Family Health Survey-5

Abstract

Background: This study examines the utilisation of maternal and child healthcare services across the continuum of care and its socioeconomic determinants in Nuh district, Haryana, using data from the National Family Health Survey-5 (2019-21). The objective was to assess service coverage across antenatal care, institutional delivery, postnatal care and child health indicators, and to identify key determinants influencing completion of the continuum of care. Methods: A cross-sectional design was used, based on district-specific NFHS-5 microdata. Survey-weighted proportions were estimated, and binary logistic regression models were applied to examine associations between selected socioeconomic factors and maternal and child health outcomes. Results: The findings indicate substantial attrition across the continuum of care. Although antenatal care utilisation was relatively high, only 46.2% of women received four or more antenatal visits, and 18.5% consumed at least 100 iron-folic acid tablets. Institutional delivery coverage was 78.9%, while postnatal care within 48 hours was 70.6%. The maternal continuum-of-care completion rate was 37.5%, which declined to 17.0% when child immunisation was included. High levels of child undernutrition were observed, with stunting affecting 44.1% of children under five. Regression analysis showed that maternal education and caste were significant predictors of service utilisation at different stages of the continuum. Secondary or higher education was positively associated with institutional delivery and postnatal care. Significant disparities were also observed across caste categories, particularly in antenatal care completion and adherence to the continuum of care. Child immunisation outcomes varied across socioeconomic groups. Conclusion: The study highlights persistent inequities in maternal and child health service utilisation in Nuh district and underscores the need for targeted health-system strengthening interventions across the continuum of care.