Page 117 - IJPS-2-2

Atreyee Sinha and Aparajita Chattopadhyay

and receipt of Iron and Folic Acid (IFA) tablets or syrup for three or more months (IIPS and Macro
International, 2007). Women who had received all these services were coded as ‘1’ (full ANC) and ‘0’
(no/ partial ANC) otherwise.
Delivery conducted in a medical institution or health centre was considered as an institutional de-
livery and institutional delivery or home delivery assisted by a doctor/nurse/LHV/ANM/other health
professional was termed as ‘safe delivery’ (WHO, 2006). If the delivery took place in any medical
institution the variable was coded as ‘1’ and ‘0’ otherwise.
Covariates
In the present study, a range of socio-economic and demographic factors that were likely to be
associated with MCH care use were controlled. Background characteristics of the respondents in-
cluded individual characteristics like age, place of residence, religion, caste, wealth index and type
of family. Two important birth related characteristics — birth order and pregnancy intension — were
also included as they had direct associations with the utilization of MCH care.
Women’s empowerment is a key factor for both women’s and children’s welfare (World Bank,
2012). In the present study, we included women’s educational attainment, working status, exposure
to mass media (any digital or print media), women’s ability to take decisions regarding their own
health, freedom of movement to health facility and most importantly, the experience of spousal vi-
olence as the components of women’s empowerment. The third set of factors included supportive
social environment which comprised of availability of money for health care, presence of female
provider at the health facility, geographic accessibility (distance to health facility), presence of hus-
band during ANC check-up and getting advice on delivery care during ANC check-up. It was as-
sumed that these three sets of confounding factors would determine the utilization of MCH care ser-
vices by young married women.
Physical/sexual Violence and Emotional Violence
Spousal violence was considered as a component of women’s empowerment and an intermediate
factor determining the use of MCH care. There were nine forms of physical and sexual violence
perpetrated by a husband: slapping, twisting arms or pulling hair, pushing/shaking/throwing some-
thing at wife, punching with fists or with something that could hurt wife, kicking/dragging/beating
up, trying to choke/burn on purpose, threatening/attacking with a knife or a gun or any other weapon,
physically forcing to have sexual intercourse even when wife did not want to, and forcing wife to
perform any sexual act that she did not want to. Respondents who said ‘yes’ to any of the nine forms
of physical or sexual violence were considered as abused women; abused women were given a code
of ‘1’ and ‘0’ for the non-abused. For emotional violence, female respondents were asked whether
their husbands ever said or did anything to humiliate her in front of others, threatened to hurt or
harm her or someone close to her and insulted her to make her feel bad about herself. Respondents
who answered ‘yes’ to any of the three forms of violence were considered to be emotionally abused
and coded as ‘1’; for those who said ‘no’ to all questions, ‘0’ was assigned.
Analysis
Analyses were performed separately for the North and South states to consider the regional varia-
tion in the utilization of maternal health care services. The analytical part of the paper had three dis-
tinct sections. First section dealt with the MCH care utilization in the two regions. Various indicators
depicting the levels of MCH care utilization were presented graphically. The second section pre-
sented the situation of women’s empowerment with special focus on spousal violence in both regions.
The last section examined the association of background characteristics, women’s empowerment and
supportive social environment with the utilization of MCH care services with a special focus on
spousal violence by applying binary logistic regressions.

3. Results

Selected socio-economic and demographic characteristics of the study population are presented in

International Journal of Population Studies | 2016, Volume 2, Issue 2 111