Paper short abstract:

Transportation accessibility is key to accessing maternal health facilities, crucial in Himachal Pradesh’s challenging terrain, impacting maternal health outcomes and SDG achievement. This study uses NFHS-5 data and GIS to analyze access disparities, impacting outcomes.

Paper long abstract:

Transportation accessibility is an important factor to reach health facility specifically for maternal mortality remains a global concern, especially in regions with challenging geography. Access to transportation, access to health resources, its utilisation and health capability has a very intricate and multifaceted relationship.

The present study investigated the accessibility of transportation for pregnant women to reach public health facilities in Himachal Pradesh, a federal state in India known for its hilly terrain. Particularly we attempted to understand how household ownership of any means of transportation (two/three/four wheelers) can affect pregnant women’s health functioning using NFHS-5. Secondly utilising multiple secondary data sources we tried to understand the role of public policy in attaining SDGs goals and improving the health functioning of the pregnant women.

Further, we mapped the modes of transportation utilized, including ambulances and private vehicles, to reach these facilities with the spatial-temporal distribution of public health facilities in the state of Himanchal Pradesh. This examination was crucial given the geographical challenges posed by the hilly landscape of Himachal Pradesh, which can significantly impact accessibility to health facilities and affect maternal healthcare. We used NFHS-5 data from the DHS survey website and Geo codes for health facilities were taken from the government health department, public transportation and road network from the RCTC of Himachal Pradesh to study pregnant women's access to transportation, and public health facilities, taking into account various factors such as mobility, financial constraints, distance from home to the facility, travel time, reluctance to travel alone, and different terrain measures. All analysis were carried out using QGIS and Stata 16.

Based on the Network analysis, we found disparities in the transportation accessibility and distribution of public health facilities, with a bias towards central and densely populated areas. Many districts in Himachal Pradesh lack adequate health facility coverage and lack of public and private transportation availability, leading to poor health functioning of women. Our analysis highlights the negative impact of availability of transportation, distance and time on pregnancy care, with farther distances and time correlating with poorer outcomes. While doing the analysis of the result we used the CA framework to highlight the role of government and public policy in attaining the SDG 3.1, 3.2 and 3.8, mainly because the public services are primarily utilized by the economically and socially disadvantaged, emphasizing the importance of equitable provision to improve healthcare access and social indicators.