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Paper short abstract

This paper examines how indigenous identity causally influences maternal healthcare utilisation among tribal women in India. It questions dominant policy assumptions and calls for decolonising understandings of maternal health by centring indigenous contexts in rethinking equitable care in practice.

Paper long abstract

Maternal health policies in Global South have long been shaped by inherited models of healthcare need that often overlook indigenous populations and lived realities. Maternal health remains a critical public health concern among tribal women in India, a historically marginalised population with distinct socio-cultural conditions and traditional beliefs. Tribal identity is often framed as being associated with poverty, remoteness, and marginalisation, which constrain maternal healthcare use. Using National Family Health Survey (NFHS-5) data from four states—Odisha, Jharkhand, Chhattisgarh, and Madhya Pradesh—this paper examines how indigenous identity causally influences maternal healthcare utilisation among tribal women and how agency and structural barriers shape this relationship. The study employs inverse probability of treatment weighting (IPTW) and moderation analysis. The findings show that tribal identity does not reduce antenatal care uptake and is associated with comparable or, in Madhya Pradesh, higher utilisation than non-tribal women. In contrast, being tribal consistently lowers the probability of institutional delivery across all four states. These results raise questions about effectiveness of the financing policy Janani Suraksha Yojana, which provides incentives for hospital births. Further moderation analysis shows that media exposure increases antenatal care utilisation and narrows delivery gaps, while cumulative access barriers substantially depress both antenatal care and institutional delivery. Greater decision-making autonomy is associated with higher antenatal use but not with comparable gains in institutional delivery. The findings point to the need to decolonise dominant policy assumptions underlying maternal healthcare provision and to develop understandings of care that are more attentive to indigenous contexts and lived realities.