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

women who had experienced any form of physical or sexual violence, only 26% of them had gone
for at least 3 ANC visits as compared to 35% of those who had not experienced violence. The pro-
st
portion of women entering ANC during 1 trimester was lesser (42.9%) among the abused women
than that of the non-abused women (47.5%). Receipt of at least 2 Tetanus Toxoid (TT) injections and
Iron and Folic Acid (IFA) tablets for 90 days or more were also smaller (68.9% and 8.2% respec-
tively) if the women were abused than their non-abused counterparts (74.8% and 16.3% respective-
ly). Likewise in the South states, receipt of ANC care declined if the respondents experienced any
physical/sexual violence.
In case of delivery care it was found that institutional delivery and safe delivery were also lower
among abused women in both regions. In the North states 21% and 32% of the abused women went
for institutional and safe delivery respectively, compared to 29% and 39% of the non-abused women.
Similarly, in the South a smaller proportion of the women who had experienced spousal violence,
delivered their last child in any health centre (65%) and availed safe delivery care (72%) compared
to those who did not experience spousal violence (76% and 82% respectively). Experience of emo-
tional violence also had similar constraining effects on MCH care utilization in the two regions.
Thus, a negative association between experience of spousal violence and the utilization of MCH care
service utilization was evident.
Results from binary logistic regression (Table 4) revealed that in the North states, women who
had experienced any form of physical or sexual violence were 21% less likely (OR= 0.79) to use all
recommended types of ANC care compared to women who had not experienced any violence. In the
South similar association was observed; abused women were 32% (OR= 0.68) less likely to use full
ANC. Quite interestingly, the constraining effects of spousal violence on receipt of full ANC was
stronger in the South states. In the North states women who had experienced any physical/sexual
violence were less likely to have an institutional delivery (i.e., deliver their child at a medical institu-
tion) or a home delivery assisted by a doctor, nurse, lady health worker, auxiliary nurse midwife, or
other health professionals. Association of physical/sexual abuse and delivery care was not significant
for the South states. Experience of emotional violence also had a negative relation with antenat-
al care service utilization in the South states; women facing any emotional violence were 22% less
likely to receive full ANC (OR= 0.78) although the association was relatively weak. Likelihood of
undergoing safe delivery was around 30% lower (OR= 0.70) for those women who had experienced
emotional violence in South states. The association between emotional violence and utilization of
maternal care was not significant for the North states.
When women’s background characteristics, and supportive social and environmental factors
were controlled, it was observed that women’s empowerment played a crucial role in the utilization
of MCH care services. Women with primary or higher levels of education were nearly 1.5 to 3 times
more likely to receive full ANC and avail institutional delivery in both regions. Women’s health care
decision making was an important factor for receipt of full ANC and institutional delivery; women
who had say in the decision on own health care were 1.3 times more likely (OR=1.30) to receive full
ANC in the South and 1.2 times more likely (OR=1.20) to deliver in health facilities in the North.
Women’s ability to go to health facility unescorted improved utilization of ANC and delivery care in
the North states. Any exposure to mass media also significantly increased the likelihood of receiving
full ANC in South and institutional delivery in both regions. Birth order was the most important de-
mographic factor determining the utilization of MCH care services in both regions. Mothers of high-
er birth order children, i.e., second and 3+ orders, were significantly less likely to receive all rec-
ommended types of ANC and deliver in institutions in both regions. To a certain extent, unwanted
pregnancies also affected the receipt of ANC and delivery care in the North states, although the as-
sociation was weak.

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