International Institute for Population Sciences
Deemed to be University (An Autonomous Organization of Ministry of Health & Family Welfare, Government of India)

Maternal healthcare utilization is shaped by multiple socioeconomic and demographic factors, with family structure playing a particularly crucial role. Yet, this dimension has received limited research attention. This study examines the impact of family structure on maternal health service utilization among women in West Bengal over the last three decades, employing a mixed-methods approach. The analysis integrates data from five rounds of the National Family Health Survey and primary qualitative interviews conducted in West Bengal. Quantitative analyses employed bivariate and multivariate models (Stata), with family structure categorized as: (i) nuclear, (ii) non-nuclear with only mother-in-law (MIL) or sister-in-law (SIL), (iii) non-nuclear with both MIL and SIL, and (iv) non-nuclear without MIL or SIL. Covariates included age, education, parity, media exposure, wealth, religion, caste, residence, antenatal visits, institutional delivery, and interaction with grassroots health workers. For qualitative data, thematic analysis was done in NVivo software. Family structure significantly influenced maternal health service utilization, with notable temporal shifts. In 2005–06, women in families with only MIL or SIL were 53% more likely to receive full ANC (AOR = 1.53) than those in nuclear families, whereas those living with both MIL and SIL were 54% less likely to deliver in an institution (AOR = 0.46). By 2015–16, women with only MIL or SIL were 26% more likely to have institutional delivery (AOR = 1.26). In 2005–06, non-nuclear families without MIL or SIL also showed higher utilization (AOR = 1.76). Qualitative evidence suggests a decline in the role of the extended family, as couples increasingly make independent decisions, driven by improved access to health services, government incentives, and the active involvement of frontline health workers. Strengthening community health services and engaging extended families can further boost maternal healthcare gains.