Geographical variations in postnatal care use and associated factors in India: evidence from a cross-sectional national survey

Postnatal care (PNC) period is a critical phase for survival of mothers and newborn babies. Understanding spatial heterogeneity is essential for evidence-based policymaking in high-risk geographical areas. Moreover, there is a paucity of research on the utilization of PNC and its geographical inequalities in India. Therefore, this paper aims to identify the geographical variations in PNC use and associated socio-demographic factors among Indian women. A cross-sectional study was conducted using the 2015-2016 National Family Health Survey (NFHS-4) data. A total of 190,898 women aged 15-49 years who had a live birth in the past five years preceding the survey were utilized in this study. This study assessed the levels of PNC use across geographical regions, states, and districts. Moran's 'I' and spatial autocorrelation were carried out to identify the spatial patterns of PNC use. Bivariate and multivariate logistic regressions were employed to examine the factors associated with PNC utilization. In India, the proportion of PNC usage was 69.1% with marked variations across geographical regions. Lower use of PNC was found in the north, central, east, and northeast regions, while PNC utilization was higher in south, followed by west region of the country. This study found that educational attainment of women and household wealth status was positively correlated with PNC utilization. Women with higher education were more likely to receive PNC (adjusted odds ratio [AOR]: 1.57, 95% CI 1.49-1.65) compared to uneducated women. The odds of PNC use were 2.57 times higher (AOR: 2.57, 95% CI 2.44-2.70) among the women from the richest wealth quintile than those from the poorest wealth quintile. Furthermore, social groups, religion, women's age, age at marriage, birth order, child wantedness, and geographical region had a significant association with PNC healthcare-seeking. The findings of this study indicate evidence-based maternal healthcare programs to mitigate the identified geographical inequalities in PNC usage. Furthermore, this study suggests state- and region-specific healthcare interventions and strengthening of existing policies to improve the utilization of PNC in India.