India's Integrated Child Development Services programme; equity and extent of coverage in 2006 and 2016.

OBJECTIVE: To investigate coverage and equity of India's Integrated Child Development Services programme across the continuum of care from pregnancy to early childhood, before and after the programme was expanded to provide universal access. METHODS: The programme offers nutrition and health services to pregnant and lactating mothers and young children. We used data from nationally representative surveys in 2005-2006 and 2015-2016, including 36 850 mother-child pairs in 2006 and 190 804 in 2016. We assessed changes in the equity of use of programme services by socioeconomic quintile, caste, education and rural or urban residence. We used regression models to investigate the determinants of programme use. FINDINGS: The mean proportion of respondents using programme services increased between 2006 and 2016, from 9.6% to 37.9% for supplementary food, 3.2% to 21.0% for health and nutrition education, 4.5% to 28% for health check-ups and 10.4% to 24.2% for child-specific services (e.g. immunization, growth monitoring). Wealth, maternal education and caste showed the largest positive associations with use of services. However, expansion in service use varied at the sub-national level. Although overall use had improved and reached marginalized groups such as disadvantaged castes and tribes, the poorest quintiles of the population were still left behind, especially in the largest states that carry the highest burden of undernutrition. CONCLUSION: India's policy reforms have increased coverage of the programme at the national level, including for marginalized groups. With further scaling-up, the programme needs to focus on reaching households from the lowest socioeconomic strata and women with low schooling levels.