Page 124 - IJPS-2-2

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

and delivery care. Increasing education level ensured better utilization of healthcare services. As
suggested by many other studies, education empowers women over their circumstances in life
through proper knowledge and awareness. Educated women may have better communication with
family members, especially with husbands, and they may have the understanding of the value of
skilled health care which altogether may provide them the decision-making capacity to go for proper
health care for themselves, their children and other family members. Educated women have the
power to influence others’ decisions very subtly with their own knowledge, and ability to handle
adverse situations through in-depth understanding on different matters (Allendorf, 2010; Celik and
Hotchkiss, 2000; Furuta and Salway, 2006; Navaneetham and Dharmalingam, 2002; Singh, Rai and
Singh, 2012). Women’s autonomy does not have much effect on MCH service utilization (Singh, Rai
and Singh, 2012), but when its components like the ability to take decision on own health care,
freedom to go to the health facilities, media exposure are considered separately, women’s autonomy
is found to be positively related to utilization of health care services. Women who have the ability to
decide on own healthcare related issues are more likely to receive antenatal care and safe deli-
very care (Bloom, Wypij and Dasgupta, 2000). Birth order and, to some extent, unintended pregnan-
cies of the women negatively influenced MCH service utilization. These results were consistent with
the findings from other studies (Singh, Rai and Singh, 2012; Celik and Hotchkiss, 2000; Santhya,
Jejeebhoy and Ghosh, 2008). The possible reasons behind this may be the fact that usually
people become more concerned about the first pregnancy due to the chances of many related com-
plications and non-experience of the mother but for later pregnancies mothers may feel more confi-
dent and knowledgeable about the pregnancy care and related matters. This may restrict them to go
for skilled care during subsequent pregnancies. Sometimes higher birth order means that the family
size is bigger and economic constraints can also be a major hindrance in this regard to receive
health care service utilization (Raj, Saggurti, Balaiah et al., 2009).
Spousal violence is not a very relevant factor in explaining the use of all the maternal health care
services, especially in the case of institutional delivery. The differences found in use of MCH care
services between women who did and did not experience spousal violence can probably be explained
to a large extent by other factors such as education, wealth status, birth order and exposure to mass
media. However, in case of availing ANC services, experience of physical/sexual violence had a
strong negative influence. Therefore, any form of spousal violence can be considered as an important
determinant of the well-being of women and children in the North and South Indian states. Expe-
riencing violence in the hands of their intimate partners tends to lower the self-esteem among wom-
en and they in turn become reluctant to take proper care of themselves (Higgins, 2011). These wom-
en lack physical, mental and financial freedom and decision-making authority to avail health care
services during pregnancy. The presence of violence also reduces their power to negotiate for their
own rights, make right choices in life and thus it may eventually affect their access to quality
health care (Singh, Mahapatra and Datta, 2008).
A regional disparity in the levels of utilization of health care services clearly came out from the
study. The selected South Indian states performed better than the North Indian states in this regard,
irrespective of the levels of spousal violence. Such differences could partly be linked to the regional
diversity in terms of availability of resources and the states’ socioeconomic progress (Dyson and
Moore, 1983). The states covered under the North Indian region namely Rajasthan, Madhya Pradesh,
Uttar Pradesh and Bihar are Empowered Action Group States (EAG) or priority states as referred by
the Government of India. These states are characterized by low female literacy, poor exposure to
mass media, low age at marriage, high fertility and lower status of women. However, when the indi-
cators of development status were controlled, spousal violence still had similar negative effects on
MCH care use in both regions. It is worth mentioning that contrary to our hypotheses, spousal vi-
olence had a stronger influence in reducing the receipt of full ANC care and institutional delivery
among women in the South Indian states. The reason for such stronger influence in the South is that,
when acceptance of spousal violence is culturally embedded its occurrence is also high, as observed

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