Urban–rural maternal care gaps: lessons for equitable resilient health systems in Europe & beyond
- 1Municipal Corporation of Delhi, Government of India, Delhi, India
Abstract
Background: Continuity across the maternal healthcare pathway—from antenatal to postnatal care—is essential for reducing preventable maternal and neonatal mortality. However, inequities in access and utilization persist, particularly across urban and rural populations. These disparities are increasingly relevant for European health systems addressing inequities among migrant and underserved urban populations.
Methods: A secondary analysis of National Family Health Survey-5 (2019–21) was conducted to examine urban–rural disparities across key stages of the maternal healthcare continuum. Indicators included early antenatal care, ≥4 antenatal visits, iron–folic acid supplementation, institutional delivery, skilled birth attendance, and postnatal care within 48 hours. Urban–rural comparisons were used to assess gradients across the care pathway.
Results: A consistent gradient of inequity and progressive attrition was observed across the continuum of care. Early antenatal registration was higher in urban areas (75.5%) than rural areas (67.9%). Adequate antenatal care (≥4 visits) showed a wider gap (68.1% vs 54.2%). Iron–folic acid consumption for ≥100 days remained suboptimal, especially in rural populations (54.0% vs 40.2%). Institutional delivery was high overall but inequitable (93.8% urban vs 86.7% rural), with lower skilled birth attendance in rural areas (87.8% vs 94.0%). Postnatal care within 48 hours also showed disparity (84.6% vs 75.4%).
Conclusions: Substantial inequities persist across the maternal healthcare continuum, with systematic drop-offs from antenatal to postnatal care in rural populations. Strengthening integrated, equity-oriented primary healthcare systems is essential to ensure continuity of care. These findings offer transferable lessons for designing resilient and migrant-responsive health systems in European urban contexts.
Key messages: • Urban-rural gaps in maternal care persist globally, hindering equitable access and universal health coverage progress in Europe and beyond.
• Findings emphasize fragmented maternal care pathways and social determinants of health, offering lessons for strengthening equitable, integrated, and migrant-responsive health systems in Europe.
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BibTeX
@article{kashyap2026urbanrural,
title = {{Urban–rural maternal care gaps: lessons for equitable resilient health systems in Europe & beyond}},
author = {A Kashyap},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1482},
url = {https://doi.org/10.1093/eurpub/ckag169.1482},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Urban–rural maternal care gaps: lessons for equitable resilient health systems in Europe & beyond
AU - A Kashyap
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1482
UR - https://doi.org/10.1093/eurpub/ckag169.1482
AB - Background: Continuity across the maternal healthcare pathway—from antenatal to postnatal care—is essential for reducing preventable maternal and neonatal mortality. However, inequities in access and utilization persist, particularly across urban and rural populations. These disparities are increasingly relevant for European health systems addressing inequities among migrant and underserved urban populations. Methods: A secondary analysis of National Family Health Survey-5 (2019–21) was conducted to examine urban–rural disparities across key stages of the maternal healthcare continuum. Indicators included early antenatal care, ≥4 antenatal visits, iron–folic acid supplementation, institutional delivery, skilled birth attendance, and postnatal care within 48 hours. Urban–rural comparisons were used to assess gradients across the care pathway. Results: A consistent gradient of inequity and progressive attrition was observed across the continuum of care. Early antenatal registration was higher in urban areas (75.5%) than rural areas (67.9%). Adequate antenatal care (≥4 visits) showed a wider gap (68.1% vs 54.2%). Iron–folic acid consumption for ≥100 days remained suboptimal, especially in rural populations (54.0% vs 40.2%). Institutional delivery was high overall but inequitable (93.8% urban vs 86.7% rural), with lower skilled birth attendance in rural areas (87.8% vs 94.0%). Postnatal care within 48 hours also showed disparity (84.6% vs 75.4%). Conclusions: Substantial inequities persist across the maternal healthcare continuum, with systematic drop-offs from antenatal to postnatal care in rural populations. Strengthening integrated, equity-oriented primary healthcare systems is essential to ensure continuity of care. These findings offer transferable lessons for designing resilient and migrant-responsive health systems in European urban contexts. Key messages: • Urban-rural gaps in maternal care persist globally, hindering equitable access and universal health coverage progress in Europe and beyond. • Findings emphasize fragmented maternal care pathways and social determinants of health, offering lessons for strengthening equitable, integrated, and migrant-responsive health systems in Europe.
SN - 1101-1262
SN - 1464-360X
ER -