Pregnancy Care in Himachal Pradesh

Himachal Pradesh has built a reputation for prioritizing maternal and child healthcare with sustained investment and a strong policy focus. Most districts in the state have adequate health infrastructure as per the Indian Public Health Standards. So it is often presented as a model state for public health. The National Family Health Survey-5 reveals that most women in the state get antenatal care, safe delivery services and postnatal support. 

On paper, the system seems efficient and inclusive. But do strong health indices reflect genuine access to pregnancy-related services, or do they mask underlying disparities? 

To explore this question, Pragyan Monalisa Sahoo, Symbiosis International (Deemed) University, Pune collaborated with researchers from  Manipal University, Jaipur, the Central University of Gujarat and Utkal University, Bhubaneswar. The research team focused on antenatal, intranatal and postnatal care.

At first, the data seemed reassuring. Most women were receiving antenatal checkups. Nearly nine in ten had access to safe delivery and postnatal care. But a deeper investigation revealed a different story. Only about 60 percent of women received complete pregnancy care. In other words, nearly four out of ten women missed at least one critical stage of care.

Why do these gaps persist? 

Using population-based norms, most districts appear well served as per the National Family Health Survey-5 report. But many areas in the state can remain cut off for months by snowed-up passes. Narrow mountain roads make movement slow and dangerous. 

So the researchers combined survey data with geospatial and administrative datasets. Using spatial mapping and buffer analysis, they estimated how far women lived from health facilities. Field visits helped verify whether health care centres were well equipped to provide services.

The researchers defined distances to health facilities: five kilometres to a primary centre, twenty to a secondary facility and fifty to a tertiary hospital. When access was redefined in terms of travel distances, the picture changed.

Districts such as Chamba, Kinnaur, Kullu and Lahaul and Spiti showed particularly poor access to healthcare. In many areas, health facilities were too far away. In winter, snowfall can block roads entirely, making access not just difficult, but impossible.

Primary and secondary healthcare should be bolstered, especially in the remotest parts, say the researchers. Roads should be improved along with the provision of emergency medical vehicle services. Mobile medical units and telemedicine can be effective means of reaching women in isolated areas, say the researchers.

They used statistical models to see how other factors such as the rural urban divide, education, economic status and caste impact health care access.

Women in rural areas had lower access compared to urban women. Women with little or no education were significantly less likely to receive care at every stage. Income had an even stronger effect. Women from poorer households were far less likely to access full care. In fact, financial status had nearly twice the impact of education.

Interestingly, once income and education were considered, caste differences were not consistently significant.

Improving maternal health can never be only about increasing the number of hospitals. It requires rethinking in terms of distance, travel time, education and socio-economic disparities. Removing the obstacles of finance and education has to be at the core of efforts towards the provision of fair maternal care, say the researchers. Until this happens, women living in isolated mountain regions will most likely continue to face risks during pregnancy.

If a state like Himachal Pradesh, usually characterized as a healthcare frontrunner, still experiences very substantial maternal care deficiencies, one can only guess what the situation is like in other states with remote and mountainous poor areas.  

BMC Pregnancy and Childbirth 26:6 (2026);
DOI: 10.1186/s12884-025-08478-z 

Reported by Kashifa Wisal
Symbiosis Institute of Media and Communications

Tagged as: Bhubaneswar, Central University of Gujarat, Jaipur, Manipal University, Pragyan Monalisa Sahoo, Pune, Symbiosis International (Deemed) University, Utkal University

Categorised in: Himachal Pradesh, Maharashtra, Medicine