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

olence respectively. These four states were combined as North Indian states and were referred as the
North states henceforth. The second group of states consisted of Maharashtra, Andhra Pradesh, and
Tamil Nadu with the level of spousal violence at 33.4%, 36.8%, and 44.1% respectively. These three
states were grouped as South Indian states and were referred as the South states (IIPS and Macro
International, 2007). The selection of states was based on the higher incidence of spousal violence in
order to avoid the variations in the prevalence of spousal violence and to compare its effects on the
utilization of MCH care services.
The sample for this study was young married women, aged 15–30 years, with at least one
live birth in the five years prior to the survey. The sample size was 4,837 for the North and 3,304 for
the South. According to national survey (IIPS and Macro International, 2007) a majority of the ever
married women interviewed for domestic violence schedule, reported that the perpetrator of physical
violence were their husband and also spousal violence was mostly experienced by women at lower
ages, i.e., below 30 years (IIPS and Macro International, 2007). Therefore, we restricted the sample
to young (15–30 years) married women. On the other hand, NFHS-3 collected information on dif-
ferent components of antenatal care (ANC) for the most recent birth and on delivery care for
all births in the last five years preceding the survey. So, women who had at least one birth in the five
years preceding the survey were considered for analysis.

2.2 Analytical Approaches

2.2.1 Conceptual Framework
A conceptual framework (Figure 1) was developed to represent the possible linkages among different
sets of variables included in the study. The main outcome of interest was MCH care utilization with
full ANC and institutional delivery as the two selected indicators. It was conceptualized that utiliza-
tion of MCH care would be determined through the interplay of a set of covariates like respon-
dents’ basic background characteristics, their empowerment and supportive social environment.
Domestic violence was considered as an important intermediate factor that might influence
health care utilization. The different variables included in the study are described below.
Outcome Variables
The major outcomes of interest were receipt of full antenatal care (ANC) and institutional deli-
very for the most recent birth. Full ANC was defined as receipt of three or more antenatal check-ups
(with the first check-up in the first trimester of pregnancy), two or more Tetanus Toxoid (TT) injections

Figure 1. Conceptual Framework

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