{
  "abstract": "Introduction: Community-based primary care aims to reduce geographic and opportunity–cost barriers in rural settings, yet population trends in coverage, content and education-related inequality are poorly described. In rural Uttar Pradesh (UP), monthly community health sessions (Village Health and Nutrition Days (VHNDs)) provide integrated antenatal care (ANC) and routine immunisation (RI). We describe long-term trends in coverage, content and education-related inequality, with direct observation of session readiness.\n\nMethods: We analysed repeated cross-sectional rural UP household survey data from National Family Health Survey (NFHS)-3 (births 2001–2006), NFHS-4 (2011–2016) and NFHS-5 (2018–2020). Outcomes included any and community-level ANC/RI, content-qualified ANC (Antenatal Care Quality (ANCq) ≥8), full RI among children aged 12–23 months and ultrasound use and caesarean birth as facility-dependent comparators. Education-related inequality was quantified using the Slope Index of Inequality and Concentration Index (CIX). Direct observations of 61 133 VHND sessions (2022–2023) described input readiness and observed ANC component delivery.\n\nResults: Between 2001 and 2019, any ANC increased from 51.3% to 94.8% and content-qualified ANC from 3.3% to 53.3%. Any RI remained high throughout; full RI increased from 20.8% (2004) to 71.2% (2019). Gains were largest among women with no formal education. Relative inequality narrowed for every indicator and fell close to zero for services deliverable at community level (CIX 0.502 to 0.059 for ANCq, 0.269 to 0.018 for full RI), while remaining substantial for caesarean birth (0.394 to 0.257). Sessions showed high blood pressure and haemoglobin testing capacity and strong availability for key antigens, with lower but improving urine testing and measles-rubella vaccine supply.\n\nConclusions: Content-qualified ANC and full immunisation improved markedly, with the largest gains among the least educated women and relative inequality narrowed for every indicator except caesarean birth. Where community-deliverable services have converged across education groups, the remaining gap lies in facility-dependent care. Further gains likely depend on referral, transport and surgical capacity rather than extending first-contact outreach.",
  "abstract_shown": true,
  "affiliations": [
    "University of Manitoba, Winnipeg, Manitoba, Canada",
    "India Health Action Trust, Lucknow, Uttar Pradesh, India",
    "Universidade Federal de Pelotas, Pelotas, Brazil"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Esther Shoemaker",
      "orcid": "0000-0003-4552-4978"
    },
    {
      "affs": [
        0
      ],
      "name": "Emma Sandstrom",
      "orcid": "0009-0001-8030-9037"
    },
    {
      "affs": [
        1
      ],
      "name": "Ravi Prakash",
      "orcid": "0000-0003-3715-5789"
    },
    {
      "affs": [
        1
      ],
      "name": "John Anthony",
      "orcid": "0000-0002-5574-7051"
    },
    {
      "affs": [
        2
      ],
      "name": "Fernando C Wehrmeister",
      "orcid": "0000-0001-7137-1747"
    },
    {
      "affs": [
        0
      ],
      "name": "Aruni Tennakoon",
      "orcid": "0000-0002-8531-0272"
    },
    {
      "affs": [
        0
      ],
      "name": "Lorine Pelly",
      "orcid": "0000-0001-6727-2164"
    },
    {
      "affs": [
        1
      ],
      "name": "Bidyadhar Dehury",
      "orcid": "0000-0001-8708-6115"
    },
    {
      "affs": [
        1
      ],
      "name": "Amit Kumar Agrawal",
      "orcid": "0009-0001-3064-7409"
    },
    {
      "affs": [
        0
      ],
      "name": "Vasanthakumar Namasivayam",
      "orcid": "0000-0001-7905-0155"
    },
    {
      "affs": [
        1
      ],
      "name": "Dhanunjaya Rao Chintada"
    },
    {
      "affs": [
        1
      ],
      "name": "Shajy Isac",
      "orcid": "0000-0002-4272-7748"
    },
    {
      "affs": [
        0
      ],
      "name": "Ramesh Banadakoppa Manjappa"
    },
    {
      "affs": [
        0
      ],
      "name": "James Blanchard",
      "orcid": "0000-0002-4701-590X"
    },
    {
      "affs": [
        0
      ],
      "name": "Marissa L Becker",
      "orcid": "0000-0002-9235-0547"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/20qxjy63b8wtv.bib",
  "cited_by": 1,
  "doi": "10.1136/bmjph-2026-005227",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13735361/",
  "id": "20qxjy63b8wtv",
  "issns": [
    "2753-4294"
  ],
  "landing_url": "https://doi.org/10.1136/bmjph-2026-005227",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "Original Research"
    ],
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      "openalex",
      "2735|Global Maternal and Child Health"
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  "openalex": "W4399417975",
  "pdf_url": "https://bmjpublichealth.bmj.com/content/4/4/e005227.full.pdf",
  "pmcid": "PMC13735361",
  "pmid": "42990801",
  "published": "2026-11-02",
  "publisher": "BMJ Publishing Group",
  "ris": "https://research.draconitic.com/paper/20qxjy63b8wtv.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:21:03Z",
      "native_id": "PMC13735361",
      "source": "pmc",
      "url": "https://doi.org/10.1136/bmjph-2026-005227"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2735|Global Maternal and Child Health",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Contact coverage, content of care and inequality in antenatal care and routine immunisation in rural Uttar Pradesh, India: a repeated cross-sectional analysis of household surveys and direct observations of community health sessions",
  "title_text": "Contact coverage, content of care and inequality in antenatal care and routine immunisation in rural Uttar Pradesh, India: a repeated cross-sectional analysis of household surveys and direct observations of community health sessions",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:21:03Z",
  "url": "https://research.draconitic.com/paper/20qxjy63b8wtv",
  "venue": "BMJ Public Health",
  "versions": []
}