In the past two decades, India has made remarkable progress in expanding maternal healthcare. More women are now registering pregnancies, attending antenatal clinics and delivering in health facilities than ever before. However, a rise in number of women visiting clinics does not necessarily indicate the quality of care they receive.
A recent study by researchers from the University of Allahabad and the Govind Ballabh Pant Social Science Institute shifts the conversation from the number of visits to the quality of care received during those visits. The analysis is based on district-level indicators derived from the National Family Health Survey (NFHS-5, 2019-21). As per the World Health Organization recommendations on essential antenatal care components, the study uses seven ser-vice indicators available in the NFHS data: blood pressure measurement, blood sample testing, urine examination, tetanus toxoid vaccination, iron-folic acid supplementation, weight measurement, and counselling or related clinical checkups during pregnancy. For the study, the researchers examined whether women received at least five of seven essential ante-natal care components.
The results show that nationally, nearly nine in 10 women receive this minimum package of care. But the average conceals geographical variation.
In many areas, access to quality antenatal care (Q-ANC) still depends as much on geography as on the health system itself. The study identifies 156 districts as hotspot regions, indicating significantly higher Q-ANC utilisation surrounded by districts with similarly high levels. These clusters are predominantly in Kerala, Karnataka, Tamil Nadu, Andhra Pradesh, Telangana, and Odisha, with coverage exceeding 85 per cent in most districts. In contrast, 88 districts are identified as cold spot regions, representing areas with persistently low Q-ANC utilisation surrounded by similarly low-performing dis-tricts. These cold spots are primarily in Bihar, Uttar Pradesh, Arunachal Pradesh, and Nagaland, with smaller pockets observed in Meghalaya, Mizoram, and western Uttar Pradesh (see ‘Regional variations’).
The study also finds huge variation within states …
This article was originally published in the October 16-31, 2026 print edition of Down To Earth