Advertisement

Journal of Urban Health

, Volume 88, Issue 2, pp 311–328 | Cite as

Intra-urban Differentials in the Utilization of Reproductive Healthcare in India, 1992–2006

  • Abhishek KumarEmail author
  • Sanjay K. Mohanty
Article

Abstract

This paper examines trends in three reproductive healthcare indicators— namely, antenatal care, medical assistance at delivery, and contraceptive use among the urban poor and non-poor in India using data from the National Family Health Surveys, 1992–1993 and 2005–2006. The urban poor and non-poor are derived from composite wealth indices based on a set of economic proxies. Results indicate that the estimates of poor and non-poor are reliable. During the last 14 years, the service coverage in all three indicators has increased in the country, among both the urban poor and non-poor. However, the utilization of reproductive health services is concentrated among the urban non-poor cutting across the states, with the exception of Kerala. While the non-poor/poor gap in antenatal care and medical assistance at delivery remained large over the years, the gap in contraceptive use has narrowed down cutting across states. After adjusting for other confounders, household poverty was found to be a significant barrier in the utilization of reproductive healthcare services across the states. It has been observed that the utilization of reproductive healthcare services followed a continuum of rural total, urban poor, and urban non-poor.

Keywords

Urbanization Poverty Urban poor Antenatal care Medical assistance at delivery Contraceptive use Concentration index India Asia 

Notes

Acknowledgments

An earlier version of this paper was presented at the annual meeting of the Population Association of America (PAA) at Dallas, Texas, USA, April 15–17, 2010. We are thankful to Dr. Ann K. Blanc, Director of the Maternal Health Task Force, New York, USA and Dr. Anrudh Jain and Saumya RamaRao, Population Council, New York, USA for their valuable comments and suggestion on the previous draft of the paper.

References

  1. 1.
    World Urbanization Prospects. The 2007 Revision Population Database, World Population Prospects: the 2006 Revision and World Urbanization Prospects.Google Scholar
  2. 2.
    Wratten E. Conceptualizing urban poverty. Environ Urban. 1995; 7(1): 11–38.CrossRefGoogle Scholar
  3. 3.
    United Nations Population Fund. The state of the world population 1996. Changing places: population, development and the urban poor. New York: United Nations; 1996.Google Scholar
  4. 4.
    UN-HABITAT. The Millennium Development Goals and Urban Sustainability. The State of the World’s Cities 2006/7. http://users.bigpond.net.au.
  5. 5.
    Rossi-Espagnet A, Goldstein GB, Tabibzadeh I. Urbanization and health in developing countries: a challenge for health for all. World Health Stat Q. 1991; 44(4): 186–244.Google Scholar
  6. 6.
    Monica MA, Zulu EM, Brockerhoff M. The inequality of maternal health care in urban sub-Saharan Africa in the 1990s. Pop Stud. 2003; 57(3): 347–366.CrossRefGoogle Scholar
  7. 7.
    Montgomery MR, Hewett PC. Urban poverty and health in developing countries: household and neighborhood effects. Demography. 2005; 42(3): 397–425.PubMedCrossRefGoogle Scholar
  8. 8.
    Monica M. Maternal and child health among the urban poor in Nairobi, Kenya. African Pop Stud. 2004; 19(2): 179–198.Google Scholar
  9. 9.
    Harpham T, Lusty T, Vaughan P. In the shadow of the city: community health and the urban poor. Oxford: Oxford University Press; 1998.Google Scholar
  10. 10.
    Bradley D, Stephens C, Harpham T, Cairncross S. A review of environmental health impacts in developing countries. Urban management program discussion paper 6. Washington: World Bank; 1992.Google Scholar
  11. 11.
    Timaeus I, Lush L. Intra-urban differentials in child health. Health trans Rev. 1995; 5: 163–190.Google Scholar
  12. 12.
    Atkinson AM. Rural and urban families’ use of child care. Family Relations. 1994; 43(1): 16–22.CrossRefGoogle Scholar
  13. 13.
    Brockerhoff M, Brennan E. The poverty of cities in developing countries. Pop Develop Rev. 1998; 24(1): 75–114.CrossRefGoogle Scholar
  14. 14.
    UNICEF. Poverty and exclusion among urban children, Innocenti digest No. 10, UNICEF Innocenti Research Centre (www.unicef-isdc.org).
  15. 15.
    de Poel EV, O’Donnell O, Doorslaer EV. Are urban children really healthier? Evidences from 47 developing countries. Soc Sci Med. 2007; 65: 1986–2003.CrossRefGoogle Scholar
  16. 16.
    Office of the Registrar General & Census Commissioner. Census of India, 2001, Final Population Totals, Series-1, Registrar General, Government of India, New Delhi; 2004.Google Scholar
  17. 17.
    Bhagat RB. Rural-urban classification and municipal governance in India. Singapore J Tropical Geo. 2005; 26(1): 61–73.CrossRefGoogle Scholar
  18. 18.
    Planning commission of India. Report of the expert group on estimation of proportion and number of poor. New Delhi: Press Information Bureau; 2007.Google Scholar
  19. 19.
    International Institute for Population Sciences (IIPS) & MACRO International. Health and living conditions in Eight Indian Cities. National Family Health Survey (NFHS-3), 2005–06: Mumbai, India: IIPS; 2007.Google Scholar
  20. 20.
    Mulgaonkar VB, Parikh IG, Taskar VR, Dharap ND, Pradhan, VP. Perception of Bombay slum women regarding refusal to participate in a gynecological health program; 1994.Google Scholar
  21. 21.
    Brockerhoff M, Biddlecom AE. Migration, sexual behaviour and the risk of HIV in Kenya. Intern Migration Rev. 1999; 33(4): 833–856.CrossRefGoogle Scholar
  22. 22.
    Islam M, Montgomery M, Taneja S. Urban health and care-seeking behavior: a case study of slums in India and the Philippines. Bethesda: The Partners for Health Reformplus Project, ABT Associates Inc; 2006.Google Scholar
  23. 23.
    APHRC. Averting preventable maternal mortality: delays and barriers to the utilization of emergency obstetric care in Nairobi’s informal settlements. Unpublished report of the World Bank-funded Maternal Health Survey; 2006.Google Scholar
  24. 24.
    Rutstein S, Johnson K, Montana L. Targeting Health Services to the Urban Poor: is Slum Geography Enough? Paper presented at the XXV International Population Conference, International Union for the Scientific Study of Population, Tours, France; 2005.Google Scholar
  25. 25.
    Khan Z, Mehnaz S, Khalique N, Ansari MA, Soddiqui AR. Poor perinatal care practices in urban slums: possible role of social mobilization networks. Ind J Commu Medic. 2008; 34(2): 102–107.Google Scholar
  26. 26.
    Gupta M, Thakur J, Kumar R. Reproductive and child health inequalities in Chandigarh Union Territory of India. J Urban Health. 2008; 85: 291–299.PubMedCrossRefGoogle Scholar
  27. 27.
    African Population and Health Research Centre (APHRC). Health and livelihood needs of residents of informal settlements in Nairobi City. Nairobi: African Population and Health Research Centre; 2002.Google Scholar
  28. 28.
    UN-HABITAT. State of the world’s cities 2006/7. London: Earthscan publications Ltd.Google Scholar
  29. 29.
    Madise N, Diamond I. Determinants of infant mortality in Malawi: an analysis to control for death clustering within families. J Bio Soc Sci. 1995; 27(1): 95–106.Google Scholar
  30. 30.
    Stephenson R. The impact of rural-urban migration on child survival in India. Unpublished thesis submitted for M.Phil. Candidature to the Department of Social Statistics, University of Southampton, UK; 1998.Google Scholar
  31. 31.
    Sen A. Population: delusion and reality. New York Review, September 22, 1994.Google Scholar
  32. 32.
    Chattopadhyay A, Roy TK. Are urban poor doing better than their rural counterpart in India? A study of fertility, family planning and health. Demography India. 2005; 34(2): 299–312.Google Scholar
  33. 33.
    Ladusingh L, Singh HC. Rich-poor gap in maternal care: the case of northeast India. Asian Pop Stud. 2007; 3(1): 79–94.CrossRefGoogle Scholar
  34. 34.
    Mohanty SK, Pathak PK. Rich-poor gap in utilization of reproductive and child health services in India. J Bio Soc Sci. 2008; 41(03): 381–398.Google Scholar
  35. 35.
    International Institute for Population Sciences (IIPS), MACRO International. National Family Health Survey (NFHS-3), 2005–06: India. Mumbai: IIPS; 2007.Google Scholar
  36. 36.
    Montgomery MR, Grangnolati M, Burke KA, Paredes E. Measuring living standards with proxy variables. Demography. 2000; 37(2): 1556–1574.CrossRefGoogle Scholar
  37. 37.
    Vyas S, Kumaranayake L. Constructing Socio-economic status indices: how to use principal component analysis. Health Policy Plann. 2006; 21(6): 459–468.CrossRefGoogle Scholar
  38. 38.
    Filmer D, Pritchett H. Estimating wealth effects without expenditure data-or tears: an application to educational enrollments in states of India. Demography. 2001; 38(1): 115–132.PubMedGoogle Scholar
  39. 39.
    International Institute for Population Sciences (IIPS), MACRO International. National Family Health Survey (NFHS-1), 1992–93: India. Mumbai: IIPS; 1993.Google Scholar
  40. 40.
    International Institute for Population Sciences (IIPS), MACRO International. National Family Health Survey (NFHS-2), 1998–99: India. Mumbai: IIPS; 2000.Google Scholar
  41. 41.
    Mohanty SK. Alternative wealth indices and health estimates in India. Genus. 2009; LXV(2): 113–137.Google Scholar
  42. 42.
    Erreygers G. Correcting the concentration index. Research Paper 2006–07. Department of Economics, Faculty of Applied Economics, University of Antwerp. 2006.Google Scholar
  43. 43.
    StatacCorporation. Stata statistical software: Release 8.0. College Station: StataCorp; 2003.Google Scholar
  44. 44.
    Freedman LP, Graham WJ, Brazier E, et al. Practical lessons from global safe motherhood initiatives: time for a new focus on implementation. Lancet. 2007; 370: 1383–91.PubMedCrossRefGoogle Scholar
  45. 45.
    Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet. 2006; 368: 1189–200.PubMedCrossRefGoogle Scholar
  46. 46.
    Campbell OMR, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006; 368: 1284–99.PubMedCrossRefGoogle Scholar
  47. 47.
    Ram F, Singh A. Is antenatal care effective in improving maternal health in rural Uttar Pradesh? Evidence from a district level household survey. J Bio Soc Sci. 2006; 38(4): 433–438.Google Scholar
  48. 48.
    Fotso JC, Ezeh A, Oronje R. Provision and use of maternal health services among urban poor women in Kenya: what do we know and what can we do? J Urban Health. 2008; 85(3): 428–42.PubMedCrossRefGoogle Scholar
  49. 49.
    Kunst A, Houweling E. A global picture of poor–rich differences in the utilization of delivery care. Studies in Health Services Organizations and Policy. 2001; 17: 297–315.Google Scholar
  50. 50.
    Bankole A, Wesstoff CF. Mass media influences on contraceptive behavior and reproductive preferences. Paper Presented at the Annual Meeting of the Population Association of America, New Orleans, Lousiana; May 9–11, 1996.Google Scholar
  51. 51.
    Ramesh BM, Gulati SC, Retherford RD. Contraceptive use in India, 1992–93. National Family Health Survey Subject Reports No. 2. Mumbai: International Institute for Population Sciences; and Honolulu: East–West Center, Program on Population; 1996.Google Scholar
  52. 52.
    Retherford RD, Mishra VK. Media exposure increases contraceptive use. National Family Health Survey Bulletin August (7). Mumbai: International Institute for Population Sciences and Honolulu: East–West Center Program on Population; 1997.Google Scholar
  53. 53.
    Rao KV, Mishra VK, Retherford RD. Effects of exposure to mass media on knowledge and use of oral rehydration therapy for childhood diarrhea in India. National Family Health Survey Subject Report No.10. Mumbai: International Institute for Population Sciences and Honolulu: East West Center Program on Population; 1998.Google Scholar
  54. 54.
    Wong EL, Popkin BM, Guilkey DK, Akin AS. Accessibility, quality of care and prenatal care use in the Philippines. Soc Sci Med. 1987; 24(11): 927–944.PubMedCrossRefGoogle Scholar
  55. 55.
    Bhatia JC, Cleland J. Determinants of maternal care in a region of South India. Health Trans Rev. 1995; 5(2): 127–142.Google Scholar

Copyright information

© The New York Academy of Medicine 2011

Authors and Affiliations

  1. 1.International Institute for Population SciencesDeonarIndia
  2. 2.Department of Fertility StudiesInternational Institute for Population SciencesDeonarIndia

Personalised recommendations