Utilization pattern and associated factors of maternal health care services in Haryana, India: a study based on district level household survey data


  • Shinjini Ray Department of Population Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
  • Pravat Bhandari Department of Population Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
  • Jang Bahadur Prasad Department of Population Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India




Antenatal care, Institutional delivery, Haryana, DLHS, Post-delivery treatment, Women education


Background: Maternal health was one of the most important millennium development goals (MDGs), India didn’t achieve by the year 2015. Since, India is a multicultural, social and multiregional country, where some of the regions have good social and demographic achievement while some are poor. Haryana is one of them, which has 146 maternal mortality ratio. The level of receiving antenatal care (ANC) in Haryana is quite low as compared to other states of India. Objective of present study was to Understand the extent of use of maternal health care services in Haryana as well as examining the role of antenatal care and other socio-economic factors on the utilization of maternal health services.

Methods: Bivariate analysis, chi-square test, and binary logistic regression have been used based on district level household and facility survey-4 data.

Results: The utilization of ANC (any and full), institutional delivery and post-delivery treatment seeking varies among women by literacy, age at first marriage, age at women and place of residence. Literate women are two times more likely to access ANC [odds ratio (OR)=1.97 (any ANC), 1.95 (full ANC), p<0.01] and 1.52 times more likely to prefer institutional delivery [OR=1.52, p<0.01].

Conclusions: Empowering women through the encouragement of mother’s education should be one of the most fundamental strategies to promote maternal health care services and reduce inequalities.


Zahr CA, Wardlaw TM, Choi Y. Maternal mortality in 2000: estimates developed by WHO, UNICEF and UNFPA. World Health Organization; 2004.

UNICEF. The state of the world's children 2009: maternal and newborn health. Unicef; 2008. Available at https://www.unicef.org/sowc09/docs/ SOWC09-FullReport-EN.pdf. Accessed on 15 September 2017.

Registrar General of India. Special bulletin on maternal mortality in India 2010-12. New Delhi: Office of the Registrar General of India; 2013. Available at http://www.censusindia.gov.in/ vital_statistics/SRS_Bulletins/MMR_Bulletin-2010-12.pdf. Accessed on 15 September 2017.

Jahn A, De Brouwere V. Referral in pregnancy and childbirth: concepts and strategies. In: Van Lerberghe W, De Brouwere V, eds. Safe motherhood strategies: a review of the evidence studies in health services organisation and policy. 17th ed. Antwerp: ITG press; 2001:225-42.

Pallikadavath S, Foss M, Stones RW. Antenatal care: provision and inequality in rural north India. Soc Sci Med. 2004;59(6):1147-58.

Yuster EA. Rethinking the role of the risk approach and antenatal care in maternal mortality reduction. Int J Gynecol Obstet. 1995;50:S59-61.

Ram F, Singh A. Is antenatal care effective in improving maternal health in rural Uttar Pradesh? Evidence from a district level household survey. J Biosocial Sci. 2006;38(4):433-48.

Gogoi M, Unisa S, Prusty RK. Utilization of maternal health care services and reproductive health complications in Assam, India. J Public Health. 2014;22(4):351-9.

Singh PK, Rai RK, Alagarajan M, Singh L. Determinants of maternity care services utilization among married adolescents in rural India. PloS one. 2012;7(2):e31666.

Panda M, Vashisht BM. Practices related to delivery and antenatal care among females in rural block of Haryana, India. Muller J Med Sci Res. 2014;5(1):39-42.

Govindasamy P, Ramesh BM. Maternal education and the utilization of maternal and child health services in India. Mumbai, International Institute for Population Sciences and Calverton, Maryland, Macro International Inc;1997.

Thind A, Mohani A, Banerjee K, Hagigi F. Where to deliver? Analysis of choice of delivery location from a national survey in India. BMC Public Health. 2008;8(1):29.

Dixit P, Dwivedi LK, Ram F. Estimating the impact of antenatal care visits on institutional delivery in India: a Propensity score matching analysis. Health. 2013;5(05):862-78.

Chandrashekar S, Rao RP, Nair NS, Kutty PR. Socio-demographic determinants of antenatal care. Tropical Doctor. 1998;28(4):206-9.

Dwivedi LK, Reshmi RS. Role of antenatal care in utilizing maternal health care services in Maharashtra. In: Singh KK, Yadava RC, Pandey A, eds. Population, Poverty and Health. New Delhi, Hindustan Publishing Corporation; 2009:207-16.

Navaneetham K, Dharmalingam A. Utilization of maternal health care services in Southern India. Social Sci Med. 2002;55(10):1849-69.

International Institute for Population Sciences. District Level Household and Facility Survey-4: state fact sheet Haryana, 2013. Available at https://www.rchiips.org/pdf/dlhs4/report/HR.pdf.

Fatusi AO, Hindin MJ. Adolescents and youth in developing countries: Health and development issues in context. J Adolescence. 2010;33(4):499-508.

Omer SB, Goodman D, Steinhoff MC, Rochat R, Klugman KP, Stoll BJ, et al. Maternal influenza immunization and reduced likelihood of prematurity and small for gestational age births: a retrospective cohort study. PLoS Med. 2011;8(5):e1000441.

Stewart K, Sommerfelt E. Utilization of maternity care services: a comparative study using DHS data. [Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference Washington DC; 1991.

Bobhate P, Shrivastava S. A cross sectional study of knowledge and practices about reproductive health among female adolescents in an urban slum of Mumbai. J Fam Reprod Health. 2011;5(4):117-24.

Godha D, Hotchkiss DR, Gage AJ. Association between child marriage and reproductive health outcomes and service utilization: a multi-country study from South Asia. J Adolescent Health. 2013;52(5):552-8.






Original Research Articles