Progress in Key Interventions for Reproductive and Maternal Health in High Priority Districts, India: Evidence from NFHS-4 and NFHS-5

This paper assesses progress in key reproductive and maternal health (RMH) interventions in 190 high-priority districts (HPDs) across states and union territories in India using data from National Family Health Survey (NFHS) Rounds 4 and 5. The analysis of district-level performance across RMH indicators reveals the disparities and unequal progress across HPDs with results indicating a deterioration in RMH indicators in a larger number of HPDs in the non- Empowered Action Group (EAG) states compared to EAG states. The results also suggest that while some HPDs have made progress there is scope for considerable improvements in many districts that have exhibited limited progress. The cross-sectional district-level regression analysis indicates that the improvement in RMH outcomes is constrained by the poor economic status of households and the low status of women. Health infrastructure and the quality of healthcare services are also important determinants. The rising out-of-pocket expenditure in public health facilities shows the need for affordable reproductive and maternal healthcare facilities for low-income groups. The review of progress between 2015-16 and 2019-21 highlights the need for concerted district-level policy action on the indicators that show poor or regressive performance in HPDs to achieve the SDG goals in reproductive and maternal healthcare.