Disparities in integrated child development services use among adolescent mothers across Indian states: an analysis using the Andersen's behavioral model

Adolescent motherhood poses a major health risks in India, increasing maternal and neonatal complications. The Integrated Child Development Services (ICDS) programme provides vital services for children and pregnant or breastfeeding mothers. This study examines changes in ICDS utilization by adolescent mothers in India from 2005–06 to 2019–21, focusing on state-wise trends and key factors. Using pooled data on 29,336 mothers aged 15–19 years from NFHS-3, NFHS-4, and NFHS-5, we conducted descriptive and bivariate analyses of ICDS utilization during pregnancy and breastfeeding, followed by multivariable logistic regression guided by Andersen’s behavioral model. State-level convergence was assessed using a beta-convergence framework by examining the relationship between initial ICDS utilization and subsequent growth rates. ICDS utilization increased from 14.8% in 2005–06 to 65.0% in 2019–21. States with lower initial utilization generally experienced faster improvements, indicating beta convergence; however, substantial interstate disparities persisted. While Goa achieved universal coverage by 2019–21, utilization remained below 20% in states such as Manipur and Arunachal Pradesh. Higher utilization was observed among mothers with secondary education (AOR: 1.28), those belonging to Scheduled Tribes (AOR: 1.69), and those who desired their pregnancy (AOR: 1.63), with particularly high uptake in southern India (AOR: 2.97). From a policy perspective, the findings highlight the need to move beyond uniform expansion of ICDS towards state-specific and adolescent-focused implementation strategies. Strengthening frontline worker capacity, improving continuity of care across pregnancy and lactation, and prioritizing lagging states are critical for translating coverage gains into equitable service utilization among adolescent mothers.