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Utilization of maternal and child health care services in North and South India: does spousal violence matter?

sub-Saharan and south Asian countries (UNICEF, 2008; WHO, 2014). For the sake of maternal
and child welfare, it is pertinent to understand the role of women’s educational attainment, employ-
ment status, economic status, geographic accessibility to and availability of health care services and
women’s ability to decide how to spend their own earnings for self health care (Mohanty and Pathak,
2009; Navaneetham and Dharmalingam, 2002; Ram and Singh, 2006; Furuta and Salway, 2006;
Olufunmilayo and Adeoye, 2015). Women’s education, mobility, access to economic resources, sta-
tus in the household, decision making authority, economic condition of the family, and geographic
region are some important determinants of maternal health care utilization (Furuta and Salway, 2006;
Singh, Rai and Singh, 2012). In societies that are driven by men, husband’s supportive stance is al-
so considered to be an essential component in increasing utilization of maternal and child care ser-
vices (Chattopadhyay, 2011). It is argued that poor communication between couples and gender in-
equality constraint women’s access to health care services. In this regard, spousal violence can be
seen as a manifestation of unequal power relations between men and women in a marriage.
Spousal violence is any abuse or violent action that occurs between two individuals in a close re-
lationship like marriage and has many forms including physical aggression or assault, sexual and
emotional abuse, controlling or domineering (WHO, 2012). Although the term spousal violence in-
volves both men and women, with either sex as the perpetrator, the majority of abuses are perpe-
trated by men against their female partners (Krug, Dalhberg, Mercy et al., 2002). Societies with a
strong patrilineal-patrilocal-patriarchal foundation deny equality between men and women. Biased
gender role attitudes prevailing in the traditional patriarchal societies force women to be domesti-
cated and build perceptions of social roles that confine women to the four walls of a household
dwelling, with activities centred on bearing and rearing of children and caring for the family. In such
environments, women who are at the receiving end of physical, sexual and emotional abuse, learn to
accept it as the “husband’s right” (Visaria, 2000).
Spousal violence has emerged as an important public health concern in both developed and de-
veloping nations, mainly in African and Asian countries including India, as it leads to poor physical,
reproductive and mental health outcomes for women and has far reaching consequences on children
as well (Campbell, 2002; Ellsberg, Jensen, Heise et al., 2008; Silverman, Decker, Gupta et al., 2009).
Intimate partners who are physically violent may interfere with the receipt of healthcare services by
their female counterparts (McCloskey, Williams, Lichter et al., 2007). Existing literature in South
Asia and Africa suggests that presence of violence in a household may reduce the utilization of ma-
ternal and child health care services resulting in poor health status of both the mother and the child
(Monemi, Pena, Ellsberg et al., 2003). Studies in Bangladesh and Nigeria found that intimate partner
violence plays a significant role in lowering the utilization of reproductive health services among
women and concluded that in addition to a wide range of socio-demographic factors, preventing
physical and sexual violence needs to be considered as an important psychosocial determinant to
increase utilization of reproductive health care services (Ononokpono and Azfredrick, 2014; Rahman,
Nakamura, Seino et al., 2012). Using the Women's Reproductive Histories Survey (WRHS) in 2002
a study reveals that in India, among nuclear families, women with better marital relationships are
more likely than their counterparts to use antenatal care services and deliver in a health-care facility
(Allendorf, 2010).
Violence during pregnancy could be associated with negative pregnancy outcomes through
its constraining effects on women's use of preventative or curative health services (Koski, Stephen-
son and Koenig, 2011). It was observed that women who experienced physical violence during
pregnancy were less likely to receive prenatal care, a home-visit by a health worker for a prenat-
al check-up, at least three prenatal care visits, and less likely to initiate prenatal care early in the
pregnancy (Koski, Stephenson and Koeing, 2011). The goal of prenatal and ante natal care services
is to maximize the health outcomes of both the mother and the child. Proper care of the mother and
education given to the mother during pregnancy are extremely important to ensure positive effects
on maternal health as well as pregnancy outcomes. Therefore, a lack of prenatal care correlates to

108 International Journal of Population Studies | 2016, Volume 2, Issue 2