Women's autonomy and completion of continuum of care in maternal healthcare

BACKGROUND: In low- and middle-income countries, interventions to improve maternal health services throughout pregnancy, during labor, and after delivery are often targeted independently. For health optimization, it is important to adopt a more comprehensive approach and identify factors that hinder women's continuum of care (CoC) in maternal health services. This study aimed to assess the association between women's autonomy and completion of CoC in maternal health services in India. METHODS: Using the fifth National Family Health Survey, 25,515 women aged 15-49 years who had births in the past five years were analyzed. Women's autonomy was determined based on their control over decision-making (either by themselves or jointly with husband/partner) about healthcare utilization, large purchases, visits to family/relatives, and spending of money. Women were considered as having completed CoC in maternal health services if they received at least eight antenatal care visits, gave birth in health facility with skilled birth attendants, and received postnatal care within 24 hours of birth. Multivariable-adjusted logistic regression analysis was performed. RESULTS: Overall, 64.55% of women were identified as having autonomy and 13.68% had completed CoC in maternal health services. Women's autonomy was associated with significantly increased odds of completing CoC in maternal health services (AORs: 1.19, 95% CI: 1.05-1.36), after adjusting for demographic and socioeconomic covariates. CONCLUSIONS: Despite substantial progress made on maternal health services, completion of CoC remains low in India. Fostering a social climate to promote women's autonomy should be considered in comprehensive interventions to ensure completion of CoC for healthy pregnancy. KEY MESSAGES: • In India, the percentage of women who received full completion of care (CoC) in maternal healthcare services remained low. • Women's autonomy was significantly associated with higher CoC in maternal health services, highlighting the significance of women's participation in the household decision-making process.