BACKGROUND As India already missed maternal and child health related millennium development goals, the maternal and child health outcomes are a matter of concern to achieve sustainable development goals (SDGs). This study is focused to assess the gap in coverage and inequality of various reproductive, maternal, neonatal and child health (RMNCH) indicators in 640 districts of India, using data from most recent round of National Family Health Survey. METHODS A composite index named Coverage Gap Index (CGI) was calculated, as the weighted average of eight preventive maternal and child care interventions at different administrative levels. Bivariate and spatial analysis were used to understand the geographical diversity and spatial clustering in districts of India. A socio-economic development index (SDI) was also derived and used to assess the interlinkages between CGI and development. The ratio method was used to assess the socio-economic inequality in CGI and its component at the national level. RESULTS The average national CGI was 26.23% with the lowest in Kerala (10.48%) and highest in Nagaland (55.07%). Almost half of the Indian districts had CGI above the national average and mainly concentrated in high focus states and north-eastern part. From the geospatial analysis of CGI, 122 districts formed hotspots and 164 districts were in cold spot. The poorest households had 2.5 times higher CGI in comparison to the richest households and rural households have 1.5 times higher CGI as compared to urban households. CONCLUSION Evidence from the study suggests that many districts in India are lagging in terms of CGI and prioritize to achieve the desired level of maternal and child health outcomes. Efforts are needed to reduce the CGI among the poorest and rural resident which may curtail the inequality.

中文翻译：

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印度在生殖，孕产妇，新生儿和儿童健康方面的地区不平等。

背景技术由于印度已经错过了与母婴健康有关的千年发展目标，因此母婴健康成果是实现可持续发展目标（SDG）的一个令人关注的问题。这项研究的重点是使用最新一轮的全国家庭健康调查得出的数据，评估印度640个地区各种生殖，孕产妇，新生儿和儿童健康（RMNCH）指标的覆盖面和不平等状况。方法计算了一个覆盖指数（CGI）的综合指数，该指数是不同行政级别的八种预防性母婴保健干预措施的加权平均值。使用双变量和空间分析来了解印度各地区的地理多样性和空间聚类。还得出了社会经济发展指数（SDI），并将其用于评估CGI与发展之间的相互联系。比率法被用来评估CGI及其在国家层面的组成部分的社会经济不平等。结果全国平均CGI为26.23％，最低的是喀拉拉邦（10.48％），最高的是那加兰邦（55.07％）。印度几乎一半的地区的CGI都高于全国平均水平，并且主要集中在高关注度州和东北部地区。根据CGI的地理空间分析，形成了122个地区的热点，并且有164个地区处于寒冷地区。最贫穷的家庭的CGI比最富有的家庭高2.5倍，而农村家庭的CGI比城市家庭高1.5倍。结论研究的证据表明，印度的许多地区在CGI方面都处于落后状态，并且优先考虑实现预期的母婴健康水平。需要努力减少最贫困和农村居民的CGI，这可能会减少不平等现象。