Maternal Education and the Utilization of Antenatal Care Services in Uttar Pradesh, India Open Access

Shukla, Nidhi (Summer 2019)

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Antenatal care services are the first steps towards ensuring the health of mothers and the newborn. In 2015, the global maternal mortality ratio was estimated to be 216 deaths per 100,000 live births while in India maternal mortality ratio was 174 per 100,000 live births. Nigeria and India contributed to over one third of all maternal deaths worldwide in 2015. ANC can be defined as the care provided to pregnant women by skilled healthcare professionals to ensure best health conditions for both mother and baby during pregnancy. ANC classically includes risk identification, prevention and management of pregnancy-related or existing diseases and health education and health promotion. ANC helps in reducing maternal and perinatal morbidity and mortality by detecting and treating pregnancy-related complications and identifying women who are at increased risk of developing complications during labor and delivery. Further, ANC provides an opportunity to communicate with and support women, families and communities at a critical time in a woman’s life. Maternal education has been shown to enhance pregnant mothers’ self-care and is regarded as a key factor for safe and healthy delivery. Hence, there is a need for both maternal education and ANC to enhance the knowledge of expectant women and provide them with the necessary information to proactively, seek health care resources and resolve pregnancy complications effectively.


The relationship between maternal education and utilization of antenatal care was explored using the national family health survey 2015-16 (NFHS-4) data. Bivariate analyses were conducted between maternal healthcare indicators including Tetanus toxoid vaccinations, iron and folic-acid supplementation, institutional and professional delivery care, and education level of the women (illiterate, literate-less than middle school and above middle school). These analyses were compared between the state of Uttar Pradesh and all of India. Multivariate analyses were completed for receiving maternal healthcare services for births during the four years preceding the survey (outcome of interest) and maternal education (exposure of interest), controlling for socioeconomic and demographic variables.


In analyses, there is striking disparity in the utilization of the antenatal care in Uttar Pradesh. The women in Uttar Pradesh were less likely to seek antenatal care (10.7%) compared to all of India (60%). Across India, multivariate analysis confirmed the positive and significant influence of women schooling on the utilization of antenatal care. Education emerges as the single most important determinant of antenatal care service utilization in India after controlling for covariates. Women who are educated at least up to middle school were likely to receive eight times more services that the illiterate women. 


In summary, our findings suggest that education seems to be strong and significant predictor or utilization of the antenatal care services when all of India and Uttar Pradesh were considered separately. Across India, multivariate analysis demonstrated that positive and significant influence of women’s schooling on the utilization of antenatal care. Education emerges as the single most important determinant of antenatal care service utilization in India after controlling for covariates. Women with an education of at least middle school were eight times more likely to receive healthcare services than the illiterate women. This pattern was also similar for the other antenatal care services. Births to women who had completed middle school were five to eight times more likely to receive maternal care as births to literate women. From these analyses we can conclude education had the strongest impact on antenatal service utilization than any other socio-economic factor considered.

Table of Contents

CHAPTER 1: Background and Literature Review

Overview of Antenatal Care Services. 10

Benefits of Maternal Health Education During Antenatal Care. 11

Maternal Psychosocial Risk Factors and Knowledge of Antenatal care. 13

Determinants of Utilization of Antenatal Care Services. 15

Relationship Between Mothers’s Schooling and Maternal Healthcare. 16

Opportunities to Improve Maternal Health Literacy Through Antenatal Education. 17

Maternal Education and Child Health. 18

Research Gap. 19

CHAPTER 2: Manuscript

Introduction. 21

Research Background. 21

Importance of maternal education and antenatal care to improve maternal and infant health . 21

Factors affecting the utilization of antenatal care among pregnant women. 22

Effect of maternal education on antenatal care utilization and maternal outcome in hospitals of Uttar Pradesh 24

Research Problem.. 26

Significance of Study. 26

Research Questions. 27

Objectives. 27

Research Hypothesis. 27

CHAPTER 3: Research Methodology

Research Approach. 29

Data Collection. 29

Statistical Analysis. 30

Ethical Consideration. 31

Results. 31

Tables. 34

References. 38

CHAPTER 4: Public Health Implications

Future Directions. 46


Appendix A.. 48

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