The role of public health services in reducing maternal and newborn health inequalities in urban India: A survey analysis of 200,000 births over two decades

India has experienced rapid urbanization, straining the healthcare system. The National Urban Health Mission was launched in 2013 to improve access to public healthcare particularly among socio-economically disadvantaged urban populations. This study aimed to assess whether inequalities in maternal and newborn health (MNH) service coverage and outcomes between richer and poorer groups have improved at public and private sources across urban India in the last two decades. We used pooled data from four national cross-sectional surveys, the District Level Household Surveys from 2002-08 and National Family Health Survey from 2015-21, covering 94,826 and 108,152 births in urban India, respectively. We analysed trends in coverage of antenatal, delivery and postnatal care services and neonatal mortality by source across wealth deciles, and summarized inequalities using the slope index of inequality, concentration index and inequality pattern index. The study found that coverage of all MNH services, and to a lesser extent neonatal survival, increased substantially between 2002-08 and 2015-21 in urban India. Improvements were steeper among the poorest groups. Coverage by public health facilities notably increased, and NMR was lower at public than private facilities, particularly among the poorest. However, the poorest decile remained well behind all other groups, reflecting bottom inequalities. Rapid improvements with reduced inequalities in MNH service coverage appear to be driven by increased access to public sector services in urban India. It remains critical for the public healthcare system to understand and address the particular needs of the poorest groups to reduce ongoing bottom MNH inequalities in urban India.