UTILIZATION OF MATERNAL AND CHILD

HEALTH CARE SERVICES IN INDIA: DOES

WOMEN’S AUTONOMY MATTER?

SANDHYA RANI MAHAPATRO

Introduction health services and women’s general health

status has to be tied to other social and
From time immemorial Indian society is
political development efforts aimed at
patriarchal. This implies that the culture of
elevating the roles and status of women.1
India is highly gender stratified. Women’s
The International Conference on Population
position is subordinate to man in various
and Development in 1994,2 states women’s
household decision-making matters. This is
role has been a priority area not only for
manifested through gender roles, relations,
sustainable development, but also for
unequal power in various household
reproductive health.
decision-making aspects. The low status
of women in the household indicates that Women’s autonomy and its relation to
health seeking behaviour of women in reproductive behaviour is a major area of
such a traditional society greatly depends concern, as it reduces maternal mortality
on the decision of the partner or other and improves child health. A number of
elder household members. However, studies examined women’s autonomy and
women’s autonomy and its association with its relationship with reproductive health
reproductive health and behaviour have outcomes and found that the status of
emerged as a focal point of investigations women is an important determinant of
and interventions around the world. Recent maternal mortality and morbidity. Increase
studies show that status of women as an in women’s autonomy will lead to mortality
important determinant of maternal health. decline and improve health outcomes for
The Safe Motherhood Initiative has pointed women and their children.3 A study in Uttar
out that any effort to improve maternal Pradesh in North India shows that women’s

Sandhya Rani Mahapatro, Research Scholar (Population Research Centre), Institute for Social and
Economic Change, Dr. V K R V Rao Road, Nagarbhavi P.O., Bangalore - 560 072

22 The Journal of Family Welfare

autonomy is the major determinant of by their socio-economic characteristics.
maternal health care utilization.4 The study A woman with higher socio-economic
shows that women with greater freedom status in terms of better education and
of movement are more likely to receive employment has more autonomy than
antenatal care and to use delivery care. A illiterate and unemployed women. A study
study conducted by Kishor5 found women’s conducted by Rammu16 in India on urban,
autonomy to be an important explanatory dual and single earning households found
factor in child survival. Another study in that the more resources the partner brought
India has shown that women who score in to marriage, in terms of education,
greater autonomy are more likely to use income and occupational status, the
antenatal and delivery care for their last more decision-making power he/she
birth than women with lower autonomy.6 possessed. He also found that women
Better health care utilization rates has been who were gainfully employed exercised
reflected in south Indian women as they greater authority in all spheres of decision-
have greater autonomy as compared to making compared to women engaged in
north Indian.7 domestic housework only. Basu 17 stated
that female labour supply is both a matter
At the outset, some of the studies used for household decision-making and
the socio-economic, demographic status of determinant of household balance of power.
women as the best predictors of women’s Women’s participation in gainful and visible
autonomy. Some of the studies have analysed employment (Women worker in Indian
the causes of under-utilization of maternal Beedi industry) improvise their bargaining
health services and identified both quality position within the household and is
and cost of care as important influencing associated with greater gender equality in
factors.8,9 Maternal age and parity have also the distribution of household resources than
been found to be important determinants when women are employed in invisible
of health care use.10 Safilos-Rothschild11 activities. Female education and labour
uses women’s income as a key indicator force participation have been identified as
of women’s status to examine fertility in important catalyst for enhancing women’s
rural Kenya. Still others have used both bargaining power.18 Increase in bargaining
socio-economic factors and decision-making power of women helps to better utilization
autonomy indicators and suggest that socio- of maternal and child health care services.
economic indicators have direct effects as Besides, women’s own socio-economic
well.12,13 Whereas Presser and Sen14 argue status, education of husband, and place
that women’s socio-economic indicators such of residence also play a significant role in
as education and employment are often not influencing women’s autonomy. Education
sensitive enough to capture the nuances of husband allows women to participate in
of gender power relations and the ways in various decisions within the household. As
which they influence women’s and men’s compared to rural women, urban women
reproductive behaviour. A study contends have more access to outside knowledge
that assuming the low valuation of women and information which influences their
as the root cause of lower utilization is a bargaining strength within the household
simplistic notion that fails to recognize so that they participate in the household
the complex relations between women’s matters.
position and other socio-economic factors
and infrastructure that influence access to It is well documented from the above
health care.15 that, socio-economic status of women
greatly explain their decision-making
Literature indicated that autonomy of process. By addressing this paradox,
women in a society is largely influenced whether the direct indicators of decision-

Vol. 58, No.1, June - 2012 23

making or the indirect indicators are the Information was collected on the magnitude
better predictors of maternal and child of a wife’s earnings relative to her
health care utilization, an important issue husband’s earning, control over the use
that we address is the relative importance of one’s earning, women’s control over
of women’s autonomy versus the socio- resources, wife’s participation in household
economic indicators on utilization of decision making etc.
maternal and child health (MCH) care Bi-variate analysis and logistic regression
services. has been used for the purpose of this
Taking into consideration, the relation analysis.
between women’s autonomy and the Bi-variate analysis has been used to carry
reproductive health behaviour of women out the extent of differential in maternal
in relation to various socio-economic and child health indicators by different
characteristics of women, in this paper dimensions of autonomy and by their socio-
an attempt has been made to explore the economic status.
enabling factors that influence utilisation of
Logistic regression analysis has been
MCH services. The interest of this research
used to assess the influence of certain
is two fold: to examine the simultaneous
variables on the probability of occurrence
effect of women’s socio-economic and
of an event. Logistic regression models
demographic and decision-making status
were first fitted to investigate the influence
on likelihood of influence of women’s
of autonomy indicators that variables that
decision making indicators on maternal
measures more directly women’s actual and
and child health care utilization and to
perceived position within the household.
understand the relative importance of
Subsequently, the logistic regression models
women’s autonomy versus the socio-
were filled for each of the maternal and
economic indicators on utilization of
child health variables by including socio-
maternal and child health care.
economic and demographic variables of our
study to investigate the effect of women’s
Methodology autonomy on maternal health care seeking
Determinants of maternal and child behaviour. The first of these latter models
health care utilization are examined using includes women’s autonomy indicators
the third National Family Health Survey only, while the second model adds the
(NFHS-3) the latest large scale survey data socio-economic indicators.
providing information on population and
health. The NFHS-3 covered a sample of Variables used in Regression Model
over 109,041 sample households, 124,385
women age 15-49. It provides estimates Maternal and Child Health Care Indicators
for the country as a whole and all the 29 Four dichotomous dependent variables
states. The survey was conducted with the measure utilization of maternal health care.
primary objective of providing reliable and • Safe Delivery: Safe delivery is
comparable estimates of fertility, infant considered as institutional delivery
mortality, contraceptive use, reproductive performed in a health institution.
health, family size etc. for different states
of India. • Full immunization: Children who
received one dose each of the BCG and
The survey also provides information measles vaccines and three doses each
on women’s status in terms of their of the DPT and polio vaccines.
socio-economic position. Apart from this
NFHS-3 collects data on a large number • Full antenatal Care: At least three
of indicators of women’s empowerment. antenatal care visits during pregnancy,

24 The Journal of Family Welfare

 received 100 Iron Folic Acid (IFA) The degree of women’s autonomy
tablets and two Tetanus Toxoid reflecting their decision making capability
injections. in various dimension of household matters
are assessed in 5 ways:
• Assistant during delivery: This
variable explains whether the women • Decision on Large Household
received any assistance from health Purchases
professionals during delivery or • Decision on Daily Household Purchases
it occurs through traditional birth • Decision on Mobility
measures.
• Control Overspending
The explanatory variables influence each • Decision on own health care
dependent variables are the autonomy
indicators and a group of socio-economic The first two indicators on decisions
factors. about the two different kinds of purchases
(i.e., large and daily ones) were meant to
Autonomy Indicators tap into economic decision-making in the
household. It is expected that decisions on
Basic Concept of Women’s Autonomy economic matters has a significant influence
Wo m e n ’s a u t o n o m y i s q u i t e MCH behaviour.
i n t e r c h a n g e a b l e w i t h w o m e n ’s The mobility indicator that is
empowerment and women’s status. There participation in decisions about visits to
is no single accepted definition that captures families, relatives or friends was expected
the multiple dimensions of women’s to enhance women’s ability to seek and
autonomy. Women’s autonomy is a complex gain knowledge which may influence
and general term with many connotations their own and children’s health and
that is influenced both by women’s personal well-being. Women whose movement is
attributes and by the cultural norms of restricted and where their interaction with
different groups.19 The definition of women’s relatives or friends is closely monitored by
autonomy has been extensively debated and husbands and in-laws are expected to be
the indicators used for measuring autonomy less knowledgeable about health utilization
have consequently evolved.20 Autonomy of than other women who have more freedom
women can be expressed through various of movement. Likewise, if women have
channels like in terms of right to food, the right to take decision on how to spend
health care, education, employment, control money, it helps to increase the utilisation
over productive resources, decision making of health services. Similar is the case with
power etc. In most studies autonomy has decision on own health care.
been defined as the capacity to manipulate
one’s personal environment through control Socio-Economic and Demographic
over resources and information in order to Indicators
make decisions about one’s own concerns
or about close family members.6,7 The term The variables that measure socio-
autonomy as used here following the above economic status of the respondent includes
definition represented by some selected • Education of women (Illiterate,
direct measures; namely, decision on own Primary, Secondary & above)
health care, decision on how to spend • Husband’s education (Illiterate,
money, decision-making power on making Primary, Secondary & above)
large household and daily purchases,
freedom of movement to visit families or • Current work status of women (Not
relatives, etc. working and Working)

Vol. 58, No.1, June - 2012 25

• Husband’s work status (Not working decision making power is low. Decision
and Working) taken jointly is higher in case of visiting
friends and relatives while proportion
• Economic status of household( Poorest,
of others is higher in large household
poor, middle, rich, richest)
purchases.
• Caste( SC, ST,OBC and Others)
TABLE 1
• Age of the women
Percentage distribution of women by their status in
• Birth Order decision-making
Self Jointly Others
• Place of residence( Urban vs. Rural)
Control over spending 22.17 57.07 20.76

Findings Own health 24.31 34.12 41.57

Large purchase 5.58 41.48 52.93
Autonomy Characteristics of Women
Small purchase 27.03 26.88 46.09
The frequency distribution of women
in various decision-making matters are Mobility 7.54 46.42 46.04
presented in Table 1. From the Table it is Husband's money 5.55 59.59 34.87
observed that women’s sole final say on
economic matters like daily household Figure 1 shows the utilisation of health
purchases, control over spending and services by those women who have sole
decision regarding own health care is authority in household decision making
relatively higher compared to other indicators. The figure depicts that of total
decision-making indicators. Decision taken women having sole decision-making
by the women to purchase small household power, health seeking behaviour was
commodities is around 27 percent followed found to be higher in antenatal care
by decision taken regarding their own indicators. A woman with 3 ANC visits
health care matters (24.3%) and decision is 52.4 percent followed by immunisation
on how to spend money is (22.1%). On the (39.61%), 38.7 percent women going for
other hand, in the case of large household institutional delivery and 37.9 percent
purchases, control over husband’s money women is assisted by health professionals
and on mobility decisions, women’s sole during delivery.

26 The Journal of Family Welfare

 From the above it is clear that women Decision- Antenatal Place of Delivery Immuni-
although have the sole decision-making making on care Delivery care sation
power have not fully utilised health care Large household purchase
services. This implies that other many
Self 17.09 43.19 39.83 36.89
factors limit the utilization of maternal and
child health services in developing countries Jointly 16.81 39.65 38.24 36.41
including its availability, accessibility, quality, Others 14.53 37.40 36.71 33.85
and characteristics of users. These may
include distance to health care services, Daily household purchase
cost of services, quality of services, and Self 16.17 40.67 38.81 37.33
technical qualification of health practitioners,
Jointly 16.37 38.95 38.12 35.57
socio-economic status of the household,
and individual and women’s autonomy Others 14.86 37.30 36.42 33.47
in household decision-making. Hence, Mobility
for a proper understanding of the factors
Self 17.89 42.61 40.75 39.24
influencing MCH utilisation there is a
need to investigate the influence of socio- Jointly 17.57 41.97 40.10 37.61
economic and demographic factors along Others 13.29 34.67 34.40 31.85
with autonomy variables on utilisation of
MCH services. For this, first we have to see Specifically, in the case of economic
the likelihood to utilise MCH services by decision-making like large or small
decision-making as well as socio-economic household purchases and in mobility
status of women which is presented below. indicators utilisation of MCH services
was found to be higher. For e.g. in the
U t i l i s a t i o n of MCH services by
case of large household purchases, 43.1
Autonomy and Socio-economic status
percent of women who take decisions on
Tables 2 and 3 show the rate at which their own delivered in health institutions,
women use maternal and child health whereas it was 39.6 percent women
services by their autonomy and socio- whose decisions were taken jointly and
economic characteristics. Table 2 depicts 37.4 percent where others take decisions
that more women having sole authority regarding the place of delivery. Similar
in various household decision-making pattern has been observed for other
indicators utilise MCH services than those two indicators. In the case of household
women whose decisions are taken jointly decisions regarding control over
or by others. spending there is no significant difference
TABLE 2
in the magnitude of utilisation of MCH
services where she herself takes decisions
Decision-making status of women and propensity to
use MCH services
or decisions are taken jointly. However,
a different pattern has been observed
Decision- Antenatal Place of Delivery Immuni-
making on care Delivery care sation
where decisions taken with respect to
women’s own health is concerned. It is
Control over spending
observed from the Table that decision
Self 15.49 33.67 34.01 35.14
to utilise MCH services is higher where
Jointly 15.07 33.48 32.77 35.24
both husband and wife takes decision
Others 13.59 30.28 32.64 31.39
jointly. Decision to utilise ANC services
Own health is 17.1 percent where decisions are taken
Self 15.17 38.19 37.21 36.49 jointly which is 15.1 percent for decision
Jointly 17.15 41.51 39.71 36.47 taken by the respondent alone. The
Others 14.62 36.59 35.90 33.12 same pattern is also observed in case

Vol. 58, No.1, June - 2012 27

of institutional delivery and assistance TABLE 3
during delivery. For child immunization, Socio-economic status of women and propensity to
decision is equal in both groups. The use MCH services
data presented in the Table reveals Indicators
Antenatal Place of Delivery Immuni-
that women’s sole decision-making in care Delivery care sation

utilisation of MCH services is quite Economic Indicators

significant. Hence, women’s autonomy Currently working
becomes an important determinant of No 16.61 42.23 40.46 35.98
maternal mortality and morbidity since Yes 13.32 30.11 30.53 32.79
it has significant influence on utilisation Husband's Occupation
of the MCH services.
Skilled 23.59 56.82 53.3 44.65
Socio-economic factors also influence Manual/
utilisation of health care services. The agriculture 12.77 32.17 31.86 31.57
percentage of women using such services Wealth Quintile
by their socio-economic characteristics Poorest 6.05 12.72 13.8 20.29
is given in Table 3. It was found that Poor 8.82 23.51 23.75 26.44
maternal and child health care varies Middle 14.2 39.24 39.03 37.08
directly with wealth quintile of the Rich 21.65 57.87 55.64 45.15
household. The proportion of women Richest 37.86 83.66 76.55 59.19
utilising MCH services has been found
Demographic
to be higher among higher economic Indicators Age
group and systematically declines to
15-24 14.67 40.13 39.35 32.33
lower economic class. For e.g. women
25-34 17.22 39.8 38.3 38.82
with antenatal care is 6.0 percent in
35+ 11.37 24.94 24.26 26.52
poorest quintile, 8.8 percent for poor
and increased to 22 percent in the Birth Order
richest quintile. The same pattern is 1 18.77 56.98 54.16 43.56
also observed in case of other health 2 20.59 45.33 43.6 40
care indicators. Likewise women whose 3 15.42 29.46 29.85 33.05
husband is in the better occupational 4+ 7.13 16.45 16.95 21.38
profile (skilled) are more likely to go Social Indicators Caste
for maternal care utilization compared
SC 11.06 32.95 32.65 32.53
to women whose husband is in manual
ST 9.0 17.7 17.93 26.24
or in agricultural occupation. These
OBC 15.51 37.75 37.09 32.95
results clearly depict that economic
Others 21.6 52.56 49.4 43.31
factors are quite significant in influencing
utilisation of health services. Unlike other Respondent’s education
two economic indicators, there exists No 7.56 18.41 19.43 21.78
an inverse relation between utilisation Primary 13.78 37.42 37.12 37.64
of MCH service and work status of Secondary+ 27.62 67.35 62.91 52.48
women. Now coming to the demographic Husband's education
characteristics which includes age and No 7.58 17.98 19.13 21.59
birth order. From the Table it is clear that
Primary 12.08 31.46 30.82 32.28
more women in the reproductive age
Secondary+ 3.27 51.93 49.47 43.13
group and having first birth are utilizing
health services. More women in 25-34 age Place of residence
group avail ANC and immunisation than Urban 26.61 67.47 62.41 46.88
women in other age groups. Rural 11.92 28.89 29.09 31.01

28 The Journal of Family Welfare

 Likewise women in 15-24 age group overall, women having decision making
are more likely to visit health institutions power, education, social status, income,
for delivery care compared to other age urban residence, age, birth order etc. are all
groups. More women who give birth to positively related to health care utilization
their first child utilise health services, with the exception of women who are
this declines in higher birth order. This currently employed.
indicates that older women with more
number of children are less likely to use Relationship between women’s autonomy
health care services. Women who belong and their socio-economic status on MCH
to lower caste with little education are care
less likely to use MCH services. Women The analysis in this section focuses on a
from lower socio-economic status have set of outcome measures that contribute to
less exposure to the outside world, and both maternal and child health: utilization
consequently more traditional complacency of antenatal care during pregnancy, place
about their health condition, as well as of delivery, delivery care at childbirth, and
lack of knowledge about illnesses. The immunization after birth.
poor are also more likely to encounter
other constraints, such as apathy and lack Tables 4 shows the results of logistic
of concern from health care providers regressions with each of the four health
and corrupt practitioners, inhibiting their care measures as outcomes and with
access to, and utilization of services. In women’s autonomy indices and socio-
contrast, those from the higher socio- economic indicators as independent
economic strata have both more exposure variables for the state. Two separate models
to outside world and more resources to were run for each of the outcome measures.
access services. Hence, in this context it can The first model controls for the influence of
be argued that poverty interplay with lack autonomy indicators on utilisation of health
of awareness, knowledge, cost of services care services, while the full model adds
etc. are constraints to utilisation of health the socioeconomic background variables
care services. of women to examine whether the effects
of the autonomy variables are influenced
The rural-urban distribution of by the socio-economic variables or they are
utilisation of MCH services shows that the independent from such influences.
proportion of women utilising maternal and
child health services is higher in urban area Antenatal care and its relation to women’s
than in rural area. This indicates women autonomy & socio-economic characteristics
in urban areas have more access to health
In the restricted models (Model 1) which
services compared to rural women.
contain indices of women’s autonomy,
Physically, in rural areas, because of except women’s final say on own health
the lower accessibility of modern health care, all other indicators have a significant
care services near their homes, lack of positive association with the likelihood
transportation, costs of transport, and of using antenatal care. In the full model,
difficulty of walking for hours to the health after controlling for socio-economic indices,
facilities, women and children in rural area it has been found that women taking
are more likely to lag behind those from the decision in daily household purchases are
urban strata in the utilization of services. more likely to use ANC services. Model-2
shows that except for husband’s occupation
The bi-variate relationship between and education other characteristics of
the use of MCH services and various women are significantly associated with the
characteristics of women indicates that likelihood of antenatal care.

Vol. 58, No.1, June - 2012 29

Institutional delivery and its relation to significantly related to utilisation of MCH
women’s autonomy & socio-economic services.
characteristics
From the models in Table 4, it is evident Delivery care and its relation to women’s
that women’s sole and final say on all autonomy & socio-economic characteristics
the decision making variables have a Assistance received during delivery
strong positive association with the level (health professionals like doctor/nurses)
of institutional delivery obtained. More is strongly influenced by the autonomy
specifically, women who can make the final indicators like those who have final say
decision alone on how to spend money on control over spending, decision on
are more likely to go for institutional daily household purchases and who takes
delivery than women who do not have a decision to move to friends and relatives.
final say (Model 1). Decisions taken jointly At the same time decisions taken jointly
in large and daily household purchases
regarding respondents own health have a
also have a significant impact in utilising
significantly greater influence on use of pre-
delivery facilities in both models (1& 2).
natal services. However, after controlling
In the full model (Model 2), the autonomy
for other socio-economic and demographic
indicator like large household purchases
and decisions on own health care have indicators, except decision to spend on
significant association with institutional large household purchases and in mobility
delivery. The socio-economic characteristics, indicators, other indicators loose their
except for husband’s occupation, is significance.

TABLE 4
Determinates maternal and child health care utilization
(Odds Ratio from Logistic Regression)
Ante-natal care Place of Delivery Delivery care Immunization
Indicators Restricted Full Restricted Full Restricted Full Restricted Full
Model Model Model Model Model Model Model Model

Autonomy Indicators
Decision On control
over spending(Self)
Jointly 0.781*** 0.919 0.771*** 1.008 0.798*** 0.999 0.817 0.974
Others 0.775*** 1.049 0.707*** 1.221** 0.797*** 1.303*** 0.572*** 0.764
Own health care (Self)
Jointly 1.108 1.095 1.059 0.869** 1.139** 0.973 0.901 0.795
Others 1.03 1.14 0.891** 1.04 0.874** 0.981 1.04 1.013
Large household
purchase (Self)
Jointly 0.96 0.847 0.857* 0.553*** 0.931 0.685*** 0.943 0.887
Others 0.791** 0.797* 0.745*** 0.565*** 0.851* 0.732*** 0.79 0.754
Daily household
purchase (Self)
Jointly 1.034 1.132 0.894** 1.034** 0.837*** 0.947 0.728*** 0.682***
Others 1.176** 1.205** 1.03 0.981 0.962 0.902 1.085 0.972
Mobility (Self)
Jointly 1.087 1.058 1.049 1.138 0.978 1.023 1.489** 1.695***
Others 0.786** 0.875 0.756*** 0.895 0.717*** 0.824** 1.061 1.261

30 The Journal of Family Welfare

 Ante-natal care Place of Delivery Delivery care Immunization
Indicators Restricted Full Restricted Full Restricted Full Restricted Full
Model Model Model Model Model Model Model Model

Socio-economic Indicators
Respondent’s education (None)
Primary 1.415*** 1.591*** 1.377*** 1.216
Secondary+ 1.639*** 2.139*** 1.82*** 1.819***
Husband's education (None)
Primary 1.049 1.311*** 1.139* 1.002
Secondary+ 1.083 1.10761 1.109 1.188
Caste (SC)
ST 0.87 0.44*** 0.580*** 0.538***
OBC 1.261*** 1.079 1.093 0.723**
Others 1.16 1.088 1.045 0.969
Mass Media (No)
Yes 0.905 1.221*** 1.384*** 1.179
Currently working (No)
Yes 1.182* 1.433*** 1.440*** 0.908
Husband working (No)
Yes 1.33 0.898 0.801 1.884
Wealth Quintile (poorest)
Poor 1.207* 1.612*** 1.546*** 1.217
Middle 1.819*** 2.648*** 2.595*** 1.803***
Rich 2.343*** 3.574*** 3.551*** 2.069***
Richest 3.345*** 11.406*** 5.986*** 3.256***
Age (15-24)
25-35 1.364*** 1.193*** 1.122** 1.336**
35+ 1.561*** 2.442*** 2.061*** 1.922**
Birth order (1) 0.824*** 0.706*** 0.744*** 0.818
Place of residence
(Urban)
Rural 0.770*** 0.537*** 0.653*** 1.221
*** <1%; **<5%; *<10% level of significance

Child immunisation and its relation to indicators decision on own health care and
women’s autonomy and socio-economic on large household purchases does not
characteristics influence utilisation of services. In the full
In case of child immunization, indicators model after controlling for other factors, it
like how to spend money on daily is noticed that decisions taken jointly on
household purchase and decision to visit daily household purchases and decision
friends and relatives has a significant on mobility influence immunisation.
impact on child immunization. Children Occupation of women as well as her
of women who have the final say (either husband does not have any significant
jointly with partner/others) in decisions influence on utilisation of MCH services.
on day-to-day household purchases and of Similarly, the likelihood that the child is
visiting relatives or families are more likely getting full immunization is significantly
to receive all immunisation. Unlike other higher in higher economic class.

Vol. 58, No.1, June - 2012 31

Discussion and Conclusion has a significant and consistently negative
relationship with women’s health seeking
Direct measures of women’s position
behaviour. This may be attributed to
did exert a positive influence on utilisation
the confidence that comes with prior
of health care services. Women having a
experience associated with a pregnancy
say in household spending are positively
or the pressure of child care. However,
and significantly related to utilization of
husband’s occupational status does not
health care services. The reason may be
have a relation with health care utilization.
that by control over spending a woman
The reason may be due to ease and
is able to pay for the assistance of a
adequate availability of health care facilities
medical professional without having to
women do not find the need for husband’s
ask her husband for money. However, the
support for utilizing such services.
explanatory power of the decision-making
variables gets reduced after introducing the The study shows that except decision
socio-economic and demographic variables on own health care other autonomy
in the model. Among the five variables indices significantly related to use of
that measured women’s autonomy in the health services. The results of the study
household, decision on large household suggest that not all dimensions of women’s
purchases significantly influences utilisation autonomy are important predictors of
of MCH services even in the full model. health-seeking behaviour during pregnancy,
The reason may be that those who have the childbirth, and child immunization. The
decision on large household purchases have impact of autonomy indicators changes by
some control and access to more resources. the health outcomes and after including
However, freedom to go out of the house the socio-economic indicators in the
did not significantly influence utilization of model some of the indicators lost their
health services in the full model, perhaps significance.
because freedom of movement by itself did
not grant greater autonomy. The results reveal that women who are in
socio-economically advantageous position
The socio-economic and demographic are much more likely to use MCH services.
variables are highly significant and The most important result from this analysis
consistent predictors of health seeking on health-seeking behaviour is that several
behaviour of women in India. The strongest socio-economic characteristics, particularly
influence is exerted in all the indicators education of the women as well as economic
except caste and husband’s occupation in status of household have strong positive
most of the maternal and child health care association with health-care utilization.
services. It is evident from the results that Like education, women living in urban area
women who have some education are more are more likely to use maternal and child
likely to utilize maternal health services health care services particularly institutional
than women who have no education. delivery as well as antenatal care.
Likewise women belonging to higher
wealth quintile are about two to five times Although women’s autonomy indicators
more likely to utilize MCH services and it is in some cases influence the utilisation
11 times in the case of institutional delivery. of maternal and child health care, but
health-care seeking behaviours are more
This study reinforces the importance strongly affected by socio-economic factors.
of education and income as important The effects of autonomy indicators are
determinants of health care utilisation. statistically significant in some cases, but
Residing in urban area enhances the most after including the socioeconomic
likelihood of using maternity services. indicators in the model, the statistical
However, the lower utilization in rural significance is attenuated or becomes
area can be attributed to lack of availability weaker. Hence, it can be said that health
and accessibility of facilities. Birth order seeking behaviour of women not only

32 The Journal of Family Welfare

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