Background Maternal health care refers to health care for women during pregnancy, childbirth and post-partum periods. Such care not only affects the health outcomes of mothers and children but also drastically reduces maternal and neonatal deaths. Motherhood should be a positive and fulfilling experience to every woman, but for many mothers it is associated with sufferings, ill health and at times deaths. Many of the health schemes by the national and state governments are focused on the most vulnerable population and disadvantaged groups in the society, so as to provide equity in maternal healthcare services. Women belonging to scheduled castes (SC) and scheduled tribes (ST) constitute about 16.6% and 8.6% of India's population respectively. This study aims to assess the differentials between SC/ST women and non-SC/ST women in accessing antenatal care, delivery services and postnatal care in rural areas of eight districts of north Karnataka.

Methods Study used the data collected as part of the baseline household survey in the year 2012 and the end-line household survey in the year 2015 under the Project Sukshema. The study adopted systematic stratified sampling with two-staged selection of villages and selection of households and eligible women. The baseline covered 4,881 households and 5,240 ever-married women (2,628 from the SC/ST segment and 2,612 from the non-SC/ST segment) between age 15–34 years. The end-line survey covered 4,952 households and 5,154 ever-married women (2,565 from the SC/ST segment and 2,589 from the non-SC/ST segment). The study design and methods adopted were identical in both waves of the household survey.

Findings Significant differences were observed between SC/ST women and non-SC/ST women in availing antenatal care services in terms of getting pregnancy confirmation test, first trimester registration of pregnancy, receiving at least three antenatal check-ups, getting at least one tetanus toxoid and at least 100 iron folic acid tablets (P<0.001). Proportion of home deliveries was found to be significantly high among SC/ST category compared to their counterparts (30% vs. 24% during baseline survey; 22% vs. 15% during end-line survey). Proportion of women getting postnatal care, specifically on the third and the seventh day of delivery, was also found to be less among SC/ST women compared to non-SC/ST women. Availing postnatal mother and newborn care is found to be significantly less among the deprived group. Tendency of seeking treatment especially at private hospitals was observed more among non-SC/ST women, in case they experience any complications during pregnancy, delivery or soon after the delivery.

Conclusion Though significant overall improvements have been observed in access to antenatal, delivery and postnatal services for women in North Karnataka districts, women from SC/ST category suffer from lesser access compared to women from non-SC/ST category.

Grant funding (Bill & Melinda Gates Foundation) for research but no other competing interests.