The early advantage: How antenatal care shapes cognitive development in India: Evidence from Young Lives, India.

It is universally accepted that early-life conditions significantly influence cognitive development in children; however longitudinal research from low- and middle-income countries remains limited. Antenatal care (ANC) as a critical early health-system contact, has the potential to reduce developmental disparities by promoting fetal brain development and improving pregnancy outcomes. Using data from the Young Lives study, this research examines developmental trajectories of 1,918 children, tracked from age 1-15 in India. Baseline maternal ANC data were collected when the child was one year old, while cognitive outcomes, measured through the Peabody Picture Vocabulary Test (PPVT) and Mathematics test scores, were assessed at ages 5, 8, 12, and 15. Multivariable regression models were used to examine associations between maternal ANC and cognitive outcomes, adjusting for key sociodemographic covariates. Propensity Score Matching minimized bias from observed confounders, and mediation analysis tested whether parental education or mid-day meal access explained observed pathways. The study found that children whose mothers accessed ANC regularly achieved significantly higher PPVT and Math scores at age 8, attenuating but persisting through ages 12-15. While mid-day meals showed no significant mediation, parental education consistently emerged as a strong positive predictor of children's cognitive performance. Broader social determinants, such as caste, household wealth, sanitation, and access to clean water, were also significantly associated with disparities in test scores. These findings suggest that ANC functions not only as an indicator of maternal and child health but also as a potential contributor to sustained cognitive advantage during middle childhood. Strengthening ANC coverage and embedding it within multisectoral interventions in maternal health, education, nutrition, and social protection could enhance long-term developmental equity.