Research on India documents considerable heterogeneity in health and health care across states. However, while regional differences are well established, factors underlying these differences have received little attention. This paper seeks to explain disparities in delivery care across districts by focusing on three factors: (1) marriage and kinship patterns; (2) district wealth; (3) governance and quality of services. Using data from the nationally representative India Human Development Survey 2005 (IHDS) it examines the probability that the 11,905 women who had a child between 2000 and 2005 delivered in a hospital or received care from a doctor or a nurse while delivering at home. The results suggest that 47 per cent of the variation in delivery care in India is between districts while 53 per cent is between women within district. Although compositional differences in education and household wealth explain some of the variation between districts, marriage and kinship patterns, district wealth and governance each has a significant impact on shaping between-district variation in maternity care.
Abbas, A.A. , & Walker, G.J.1986. Determinants of the utilization of maternal and child health services in Jordan . International Journal of Epidemiology, 15(3), 404–07 .
2.
Andersen, Ronald M. (1995). Revisiting the behavioral model and access to medical care: does it matter?Journal of Health and Social Behavior, 36(1), 1 .
3.
Andersen, Ronald M. (1968). Behavioral model of families’ use of health service. Chicago: Center for Health Administration Studies, University of Chicago .
4.
Angeles, Gustavo , David, Guilkey , & Thomas, Mroz (1998). Purposive program placement and the estimation of family planning program effect in Tanzania . Journal of Statistical Association of America, 93, 884–99 .
5.
Banerjee, Abhijit , Iyer, Lakshmi , & Somanathan, Rohini (2004). History, social divisions, and public goods in rural India. Journal of European Economic Association, 3(2–3), 639–47 .
6.
Beegle, Kathleen , Frankenberg, Elizabeth , & Thomas, Duncan (2001). Bargaining power within couples and use of prenatal and delivery care in Indonesia . Studies in Family Planning, 32(2), 130–46 .
7.
Bhatia, Jagdish C. (1993). Levels and causes of maternal mortality in Southern India . Studies in Family Planning, 24(5), 310–18 .
8.
Bloom, Shelah S. , Wypij, David & Das Gupta, Monica (2001). Dimensions of women’s autonomy and the influence on maternal health care utilization in a North Indian city . Demography, 38(1), 67–78 .
9.
Blumberg, Rae Lesser (1991). Gender, family and economy: The triple overlap. Newbury Park, CA: Sage Publications .
10.
Bryk, Anthony, S. , & Raudenbush, Stephen W. (1992). Hierarchical models: Applications and data analysis methods. Newbury Park, CA: Sage Publications .
11.
Chaudhury, Nazmul , Hammer, Jeffrey , Kremer, Michael , Muralidharan, Karthik , & Rogers, F. Halsey (2006). Missing in action: Teacher and health worker absence in developing countries . Journal of Economic Perspectives, 20(Winter), 91–116 .
12.
Chen, Jiajian , Xie, Zhenming , & Liu, Hongyan (2007). Son preference, use of maternal health care, and infant mortality in rural China, 1989–2000 . Population Studies: A Journal of Demography, 61(2), 161–83 .
13.
Chowdhry, Prem (2007). Contentious marriages, eloping couples: Gender, caste and patriarchy in Northern India. New Delhi: Oxford University Press .
14.
Cleland, John , & Wilson, Christopher (1987). Demand theories of the fertility transition: An iconoclastic view . Population Studies, 41(1), 5–30 .
15.
Das, Jishnu , & Hammer, Jeffrey (2007). Money for nothing: The dire straits of medical practice in India . Journal of Development Economics, 83(1), 1–36 .
16.
Das, Jishnu , Hammer, Jeffrey , & Leonard, Kenneth (2008). The quality of medical advice in low income countries . Journal of Economic Perspectives, 22, 93–114 .
17.
Desai, Sonalde , Dubey, Amaresh , Joshi, B.L. , Sen, Mitali , Shariff, Abusaleh , & Vanneman, Reeve (2010). Human development in India: Challenges for a society in transition. New Delhi: Oxford University Press .
18.
Desai, Sonalde , & Johnson, Kiersten (2005). Women’s decisionmaking and child health: Familial and social hierarchies. In S. Kishor (Ed.), A focus on gender: Collected papers on gender using DHS data. Calverton, Maryland: ORC Macro .
19.
Dwyer, Daisy , & Bruce, Judith (1988). A home divided: Women and income in the third world. Stanford: Stanford University Press .
20.
Dyson, Tim , & Moore, Mick (1983). On kinship structure, female autonomy and demographic behavior in India . Population and Development Review, 9(1).
21.
Elo, Irma (2009). Social class differentials in health and mortality: Patterns and explanations in comparative perspective , Annual Review of Sociology, 35, 553–72 .
22.
Entwisle, Barbara (2007). Putting people into place . Demography, 44(4), 687–703 .
23.
Filmer, Deon , Jeffrey S., Hammer , & Lant, Pritchett (2002). Weak links in the chain: A diagnosis of health policy in poor countries . World Bank Research Observer, 15, 199–224 .
24.
Gangolli, Leena, V. , Duggal, Ravi , & Shukla, Abhay (2005). Review of health care in India. Mumbai: Centre for Enquiry into Health and Allied Themes .
25.
Goldstein, Harvey (1995). Multilevel statistical models. New York: Halsted .
26.
Guha, Ranjit (1982). A rule of property for Bengal: An essay on the idea of permanent settlement. Paris: Mouton .
27.
International Institute for Population Sciences and Macro International (2007). National Family Health Survey (NFHS-3) 2005–06, India: Volume 1. Mumbai: IIPS .
28.
Jain, Devaki , & Banerjee, Nirmala (Eds) (1985). Tyranny of the household: Investigative essays on women’s work. New Delhi: Shakti .
29.
Jejeebhoy, J. Shireen , & Sathar, A. Zeba (2001). Women’s autonomy in India and Pakistan: The influence of religion and region . Population and Development Review, 27(4), 687 .
30.
Jencks, Christopher , & Mayer, Susan E. (1990). The social consequences of growing up in a poor neighborhood. In L.E.J. Lynn , & M. McGeary (Eds), Inner city poverty in the United States. Washington D.C.: National Academy Press .
31.
Kabeer, Naila (1994). Reversed realities: Gender hierarchies in development thought. London: Verso .
32.
Kabeer, Naila (1999). Resources, agency, achievements: Reflections on the measurement of women’s empowerment . Development and Change, 30(3), 435–64 .
33.
Karnad, Renu (2004). Housing Finance and the Economy: Regional Trends, South Asia Perspectives.
34.
Karve, Irawati Karmarkar (1965). Kinship organisation in India. Bombay: Asia Publishing House .
35.
Kishor, Sunita (2005). Gender in the demographic and health surveys. In S. Kishor (Ed.), A focus on gender: Collected papers on gender using DHS data. Calverton, Maryland: ORC Macro .
36.
Koenig, M.A. , Gillian, H.C. , & Joshi, K. (2000). Quality of care within the Indian family welfare programme: A review of recent evidence . Studies in Family Planning, 31(1), 1–18 .
37.
Mason, Karen O. (1995). Gender and demographic change: What do we know?Liege: International Union for Scientific Study of Population .
38.
Mayer, Susan E. , & Jencks, Christopher (1989). Growing up in poor neighborhoods: How much does it matter?Science, 243(4897), 1441–45 .
39.
Miles-Doan, Rebecca , & Brewster, Karin L. (1998). The impact of type of employment on women’s use of prenatal-care services and family planning in urban Cebu, The Philippines . Studies in Family Planning, 29(1), 69–78 .
40.
Mistry, Ritesh , Galal, Osman , & Lu, Michael (2009). Women’s autonomy and pregnancy care in rural India: A contextual analysis . Social Science and Medicine, 69(6), 926–33 .
41.
Narayan, Deepa (Ed.) (2006). Measuring empowerment: Cross-disciplinary perspectives. New Delhi: Oxford University Press .
42.
National Academy (1997). Reproductive health in developing countries: Expanding dimensions, building solutions. Washington D.C.: National Academy Press .
43.
Navaneetham, K. , & Dharmalingam, A. (2002). Utilization of maternal health care services in Southern India . Social Science and Medicine, 55(10), 1849 .
44.
Obermeyer, C.M. , & Potter, J.E. (1991). Maternal health care utilization in Jordan: A study of patterns and determinants . Studies In Family Planning, 22(3), 177–87 .
45.
Oberoi, Patricia (1998). Family, kinship and marriage in India. Delhi: Oxford India Paperbacks .
46.
Presser, Harriet , & Sen, Gita (2000). Women’s empowerment and demographic processes: Moving beyond Cairo. Oxford: Oxford University Press .
47.
Rahman, Lupin , & Rao, Vijayendra (2004). The determinants of gender equity in India: Examining Dyson and Moore’s thesis with new data . Population & Development Review, 30(2), 239–68 .
48.
Raudenbush, Stephen, W. , & Willms, J. Douglas (1995). The estimation of school effects . Journal of Educational and Behavioral Statistics, 20(4), 307–35 .
49.
Rosenstock, Irwin, M. (1966). Why people use health services . Milbank Memorial Fund Quarterly, 44, 94–106 .
50.
Sampson, Robert J. , Morenoff, Jeffrey D. , & Gannon-Rowley, Thomas (2002). Assessing ‘neighborhood effects’: Social processes and new directions in research . Annual Review of Sociology, 28, 443–78 .
51.
Smith, Herbert L. (1989). Integrating theory and research on the institutional determinants of fertility . Demography, 26(2), 171–84 .
52.
Snijders, Tom , & Bosker, Roel (2000). Discrete Dependent Variables. Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modelling. London: Sage Publications .
53.
Stephenson, Rob , & Tsui, Amy O. (2002). Contextual influences on reproductive health service use in Uttar Pradesh, India . Studies in Family Planning, 33(4), 309–20 .
54.
Sunil, T.S. , Rajaram, S. , & Zottarelli, Lisa K. (2006). Do individual and program factors matter in the utilization of maternal care services in rural India? A theoretical approach . Social Science and Medicine, 62(8), 1943–57 .
55.
Tinker, Irene (Ed.) (1990). Persistent inequalities: Women and world development. New York: Oxford University Press .
56.
Tomlinson, B.R. (1993). The economy of modern India, 1860–1970, New Cambridge History of India. Cambridge: Cambridge University Press .
57.
Tsui, Amy Ong (2001). Population policies, family planning programs, and fertility: The record . Population and Development Review, 27, 184–204 .
58.
World Bank (2004). World development report: Making services work for the poor. Washington D.C.: Oxford University Press and World Bank .
