Problems in accessing healthcare among women in India: a district-level change analysis, 2016–2021

BACKGROUND: Limited access to healthcare services among women leads to adverse health outcomes such as high maternal mortality, untreated chronic conditions and poor reproductive and child health. METHODS: We used data from India’s National Family Health Survey 2015–16 and 2019–21 to examine district-level changes in the percentage of women facing problems in accessing healthcare (Affordability, Proximity, Permission and Support/Companionship). We also estimate how much improvement has occurred in the districts for each outcome variable. Using a geospatial method, we aligned the district geometries between two survey rounds to strengthen the policy relevance of this research. We also conducted a supplementary analysis by rural and urban areas. FINDINGS: Overall, the percentage of women experiencing problems in accessing healthcare has declined from 2016 to 2021. The most significant reduction was observed in proximity barrier, which declined from 63.20% to 56.79%. Affordability as a problem has declined over the period, but still remains as a major barrier in eastern and Northeastern India. Rural women consistently face more problems in accessing healthcare than urban women, with proximity and affordability being major problems. Overall, the percentage of women who reported all four problems has reduced from 27.15% (95% CI: 27.05 – 27.26) in 2016 to 23.19% (95% CI: 23.09—23.29) in 2021. INTERPRETATION: The observed variation in barriers to accessing healthcare by women at the district level underscores the need for a decentralized approach in healthcare policy-making with strategies focused on district-specific challenges and priorities.