Contextual influences on reproductive health service use in Uttar Pradesh, India

This study examines the determinants of tire use of four types of reproductive health-care services in Uttar Pradesh, India: contraceptive services, antenatal care, delivery in a medical institution, and services dealing with reproductive tract and sexually transmitted infections. The analysis uses a multilevel modeling strategy to assess the presence of household- and community-level variation in service use. The influence of community-level characteristics and reproductive health-care service attributes on service use is examined. The results highlight strong community-level influences on service use, although the type of community effect varies by service type. The role of some individual and household factors in determining a person's use of services is mediated by the characteristics of the community in which tire individual lives. The results demonstrate the need to look beyond individual factors when examining health-care-seeking behavior, and illustrate that there is no singular 'community' effect on service use. (STUDIES IN FAMILY PLANNING 2002; 33[4]: 309-320)
Studies of the use of reproductive health-care services have focused on the influence of individual and household characteristics and have largely ignored the influence of community attributes and the characteristics [...]