Digital access as public health infrastructure: Evidence on maternal healthcare utilization from India

Abstract Background Digital health systems are increasingly embedded in public health initiatives across low- and middle-income countries. Nevertheless, there is limited evidence on whether women’s access to digital technology—especially mobile phones—serves as a facilitating public health resource or if it deepens existing inequalities in maternal healthcare. Objectives This research investigates whether women’s access to digital tools, such as mobile phones and the Mother and Child Protection (MCP) card, serves as a foundational enabler of maternal healthcare utilization in India, with a particular focus on the adoption of four or more antenatal care visits (ANC4). Methods A mixed-methods approach incorporated a PRISMA-guided systematic review along with a quasi-experimental analysis of three waves of the National Family Health Survey (NFHS-3, NFHS-4, NFHS-5; from 2005 to 2021). State-level panel data were examined using Difference-in-Differences and Propensity Score Matching methods, with placebo and parallel trend tests conducted to ensure validity robustness. Results Throughout the country, ANC4 coverage grew between NFHS-4 and NFHS-5, especially in states with initially lower mobile ownership. Quasi-experimental data indicated that increasing mobile access was notably linked to a 9.2 percentage-point rise in ANC4 use in areas with weak digital infrastructure. Both the systematic review and empirical analysis underscore that digital access forms a vital part of health system infrastructure, shaped by governance and trust. Conclusions Mobile access among women should not be viewed as a standalone technology but as an integral part of public health infrastructure. Enhancing equitable digital connectivity is crucial for advancing maternal healthcare and increasing health system accountability.