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CONTEXT: A cultural preference for sons may be a factor driving recourse to abortion in India, as women carrying female fetuses may decide to terminate their pregnancies. To assess this hypothesis, more information on the incidence of abortion, and on maternal and social correlates of the procedure, is needed. METHODS: Birth order-specific abortion ratios were calculated using the birth histories of 90,303 ever-married women aged 15–49 who participated in India's 1998-1999 National Family Health Survey. For the first four births, the association between abortion and various maternal and social variables, including the sex of the respondent's last child, was assessed using logistic regression. RESULTS: The overall abortion ratio was 17.0 per 1,000 pregnancies. The ratio increased from 5.3 per 1,000 pregnancies for first-order births to 25.8 per 1,000 pregnancies for third-order births and then declined. The strongest predictor of abortion was maternal education: Women with at least a primary education were more likely than those with no education to have had an abortion (odds ratios, 1.9–6.7). Rural residence was associated with a reduced likelihood of abortion (0.6). There was no association between the sex of a woman's previous child and the odds that she subsequently had an abortion. CONCLUSION: At the national level, it is likely that unintended pregnancy, rather than the sex of the previous child, underlies demand for abortion in India. Rising educational attainment among women may lead to an increase in the demand for abortion. [ABSTRACT FROM AUTHOR]

The objectives of this paper are to examine factors associated with use of antenatal care in rural areas of north India, to investigate access to specific critical components of care and to study differences in the pattern of services received via health facilities versus home visits. We used the 1998–1999 Indian National Family Health Survey of ever-married women in the reproductive age group and analysed data from the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh (n=11,369). Overall, about three-fifths of rural women did not receive any antenatal check-up during their last pregnancy. Services actually received were predominantly provision of tetanus toxoid vaccination and supply of iron and folic acid tablets. Only about 13% of pregnant women had their blood pressure checked and a blood test done at least once. Women visited by health workers received fewer services compared to women who visited a health facility. Home visits were biased towards households with a better standard of living. There was significant under-utilisation of nurse/midwives in the provision of antenatal services and doctors were often the lead providers. The average number of antenatal visits reported in this study was 2.4 and most visits were in the second trimester. Higher social and economic status was associated with increased chances of receiving an antenatal check-up, and of receiving specific components including blood pressure measurement, a blood test and urine testing but not the obstetric physical examination, which was however linked to ever-use of family planning and the education of women and their husbands. Thus, pregnant women from poor and uneducated backgrounds with at least one child were the least likely to receive antenatal check-ups and services in the four large north Indian states. Basic antenatal care components are effective means to prevent a range of pregnancy complications and reduce maternal mortality. The findings indicate substantial limitations of the health services in overcoming socio-economic and cultural barriers to access. [Copyright &y& Elsevier]