UTILIZATION OF MATERNAL AND CHILD

HEALTH CARE SERVICES IN INDIA: DOES

WOMEN’S AUTONOMY MATTER?

SANDHYA RANI MAHAPATRO

Introduction health services and women’s general health

From time immemorial Indian society is
patriarchal. This implies that the culture of
India is highly gender stratified. Women’s
position is subordinate to man in various
household decision-making matters. This is
manifested through gender roles, relations,
unequal power in various household
decision-making aspects. The low status
of women in the household indicates that
health seeking behaviour of women in
such a traditional society greatly depends
on the decision of the partner or other
elder household members. However,
women’s autonomy and its association with
reproductive health and behaviour have
emerged as a focal point of investigations
and interventions around the world. Recent
studies show that status of women as an
important determinant of maternal health.
The Safe Motherhood Initiative has pointed
out that any effort to improve maternal
status has to be tied to other social and
political development efforts aimed at
elevating the roles and status of women.1
The International Conference on Population
and Development in 1994,2 states women’s
role has been a priority area not only for
sustainable development, but also for
reproductive health.
Women’s autonomy and its relation to
reproductive behaviour is a major area of
concern, as it reduces maternal mortality
and improves child health. A number of
studies examined women’s autonomy and
its relationship with reproductive health
outcomes and found that the status of
women is an important determinant of
maternal mortality and morbidity. Increase
in women’s autonomy will lead to mortality
decline and improve health outcomes for
women and their children.3 A study in Uttar
Pradesh in North India shows that women’s

Sandhya Rani Mahapatro, Research Scholar (Population Research Centre), Institute for Social and
Economic Change, Dr. V K R V Rao Road, Nagarbhavi P.O., Bangalore - 560 072

22 The Journal of Family Welfare

autonomy is the major determinant of
maternal health care utilization.4 The study
shows that women with greater freedom
of movement are more likely to receive
antenatal care and to use delivery care. A
study conducted by Kishor5 found women’s
autonomy to be an important explanatory
factor in child survival. Another study in
India has shown that women who score
greater autonomy are more likely to use
antenatal and delivery care for their last
birth than women with lower autonomy.6
Better health care utilization rates has been
reflected in south Indian women as they
have greater autonomy as compared to
north Indian.7
At the outset, some of the studies used
the socio-economic, demographic status of
women as the best predictors of women’s
autonomy. Some of the studies have analysed
the causes of under-utilization of maternal
health services and identified both quality
and cost of care as important influencing
factors.8,9 Maternal age and parity have also
been found to be important determinants
of health care use.10 Safilos-Rothschild11
uses women’s income as a key indicator
of women’s status to examine fertility in
rural Kenya. Still others have used both
socio-economic factors and decision-making
autonomy indicators and suggest that socio-
economic indicators have direct effects as
well.12,13 Whereas Presser and Sen14 argue
that women’s socio-economic indicators such
as education and employment are often not
sensitive enough to capture the nuances
of gender power relations and the ways in
which they influence women’s and men’s
reproductive behaviour. A study contends
that assuming the low valuation of women
as the root cause of lower utilization is a
simplistic notion that fails to recognize
the complex relations between women’s
position and other socio-economic factors
and infrastructure that influence access to
health care.15
Literature indicated that autonomy of
women in a society is largely influenced
Vol. 58, No.1, June - 2012 23
by their socio-economic characteristics.
A woman with higher socio-economic
status in terms of better education and
employment has more autonomy than
illiterate and unemployed women. A study
conducted by Rammu16 in India on urban,
dual and single earning households found
that the more resources the partner brought
in to marriage, in terms of education,
income and occupational status, the
more decision-making power he/she
possessed. He also found that women
who were gainfully employed exercised
greater authority in all spheres of decision-
making compared to women engaged in
domestic housework only. Basu 17 stated
that female labour supply is both a matter
for household decision-making and
determinant of household balance of power.
Women’s participation in gainful and visible
employment (Women worker in Indian
Beedi industry) improvise their bargaining
position within the household and is
associated with greater gender equality in
the distribution of household resources than
when women are employed in invisible
activities. Female education and labour
force participation have been identified as
important catalyst for enhancing women’s
bargaining power.18 Increase in bargaining
power of women helps to better utilization
of maternal and child health care services.
Besides, women’s own socio-economic
status, education of husband, and place
of residence also play a significant role in
influencing women’s autonomy. Education
of husband allows women to participate in
various decisions within the household. As
compared to rural women, urban women
have more access to outside knowledge
and information which influences their
bargaining strength within the household
so that they participate in the household
matters.
It is well documented from the above
that, socio-economic status of women
greatly explain their decision-making
process. By addressing this paradox,
whether the direct indicators of decision-
making or the indirect indicators are the
better predictors of maternal and child
health care utilization, an important issue
that we address is the relative importance
of women’s autonomy versus the socio-
economic indicators on utilization of
maternal and child health (MCH) care
services.
Taking into consideration, the relation
between women’s autonomy and the
reproductive health behaviour of women
in relation to various socio-economic
characteristics of women, in this paper
an attempt has been made to explore the
enabling factors that influence utilisation of
MCH services. The interest of this research
is two fold: to examine the simultaneous
effect of women’s socio-economic and
demographic and decision-making status
on likelihood of influence of women’s
decision making indicators on maternal
and child health care utilization and to
understand the relative importance of
women’s autonomy versus the socio-
economic indicators on utilization of
maternal and child health care.
Methodology
Determinants of maternal and child
health care utilization are examined using
the third National Family Health Survey
(NFHS-3) the latest large scale survey data
providing information on population and
health. The NFHS-3 covered a sample of
over 109,041 sample households, 124,385
women age 15-49. It provides estimates
for the country as a whole and all the 29
states. The survey was conducted with the
primary objective of providing reliable and
comparable estimates of fertility, infant
mortality, contraceptive use, reproductive
health, family size etc. for different states
of India.
The survey also provides information
on women’s status in terms of their
socio-economic position. Apart from this
NFHS-3 collects data on a large number
of indicators of women’s empowerment.
24 The Journal of Family Welfare
Information was collected on the magnitude
of a wife’s earnings relative to her
husband’s earning, control over the use
of one’s earning, women’s control over
resources, wife’s participation in household
decision making etc.
Bi-variate analysis and logistic regression
has been used for the purpose of this
analysis.
Bi-variate analysis has been used to carry
out the extent of differential in maternal
and child health indicators by different
dimensions of autonomy and by their socio-
economic status.
Logistic regression analysis has been
used to assess the influence of certain
variables on the probability of occurrence
of an event. Logistic regression models
were first fitted to investigate the influence
of autonomy indicators that variables that
measures more directly women’s actual and
perceived position within the household.
Subsequently, the logistic regression models
were filled for each of the maternal and
child health variables by including socio-
economic and demographic variables of our
study to investigate the effect of women’s
autonomy on maternal health care seeking
behaviour. The first of these latter models
includes women’s autonomy indicators
only, while the second model adds the
socio-economic indicators.
Variables used in Regression Model
Maternal and Child Health Care Indicators
Four dichotomous dependent variables
measure utilization of maternal health care.
• Safe Delivery: Safe delivery is
considered as institutional delivery
performed in a health institution.
• Full immunization: Children who
received one dose each of the BCG and
measles vaccines and three doses each
of the DPT and polio vaccines.
• Full antenatal Care: At least three
antenatal care visits during pregnancy,
 received 100 Iron Folic Acid (IFA)
tablets and two Tetanus Toxoid
injections.
• Assistant during delivery: This
variable explains whether the women
received any assistance from health
professionals during delivery or
it occurs through traditional birth
measures.
The explanatory variables influence each
dependent variables are the autonomy
indicators and a group of socio-economic
factors.
Autonomy Indicators
Basic Concept of Women’s Autonomy
Wo m e n ’s a u t o n o m y i s q u i t e
i n t e r c h a n g e a b l e w i t h w o m e n ’s
empowerment and women’s status. There
is no single accepted definition that captures
the multiple dimensions of women’s
autonomy. Women’s autonomy is a complex
and general term with many connotations
that is influenced both by women’s personal
attributes and by the cultural norms of
different groups.19 The definition of women’s
autonomy has been extensively debated and
the indicators used for measuring autonomy
have consequently evolved.20 Autonomy of
women can be expressed through various
channels like in terms of right to food,
health care, education, employment, control
over productive resources, decision making
power etc. In most studies autonomy has
been defined as the capacity to manipulate
one’s personal environment through control
over resources and information in order to
make decisions about one’s own concerns
or about close family members.6,7 The term
autonomy as used here following the above
definition represented by some selected
direct measures; namely, decision on own
health care, decision on how to spend
money, decision-making power on making
large household and daily purchases,
freedom of movement to visit families or
relatives, etc.
Vol. 58, No.1, June - 2012 25
The degree of women’s autonomy
reflecting their decision making capability
in various dimension of household matters
are assessed in 5 ways:
• Decision on Large Household
Purchases
• Decision on Daily Household Purchases
• Decision on Mobility
• Control Overspending
• Decision on own health care
The first two indicators on decisions
about the two different kinds of purchases
(i.e., large and daily ones) were meant to
tap into economic decision-making in the
household. It is expected that decisions on
economic matters has a significant influence
MCH behaviour.
The mobility indicator that is
participation in decisions about visits to
families, relatives or friends was expected
to enhance women’s ability to seek and
gain knowledge which may influence
their own and children’s health and
well-being. Women whose movement is
restricted and where their interaction with
relatives or friends is closely monitored by
husbands and in-laws are expected to be
less knowledgeable about health utilization
than other women who have more freedom
of movement. Likewise, if women have
the right to take decision on how to spend
money, it helps to increase the utilisation
of health services. Similar is the case with
decision on own health care.
Socio-Economic and Demographic
Indicators
The variables that measure socio-
economic status of the respondent includes
• Education of women (Illiterate,
Primary, Secondary & above)
• Husband’s education (Illiterate,
Primary, Secondary & above)
• Current work status of women (Not
working and Working)
• Husband’s work status (Not working
and Working)
• Economic status of household( Poorest,
poor, middle, rich, richest)
• Caste( SC, ST,OBC and Others)
• Age of the women
• Birth Order
• Place of residence( Urban vs. Rural)
Findings
Autonomy Characteristics of Women
The frequency distribution of women
in various decision-making matters are
presented in Table 1. From the Table it is
observed that women’s sole final say on
economic matters like daily household
purchases, control over spending and
decision regarding own health care is
relatively higher compared to other
decision-making indicators. Decision taken
by the women to purchase small household
commodities is around 27 percent followed
by decision taken regarding their own
health care matters (24.3%) and decision
on how to spend money is (22.1%). On the
other hand, in the case of large household
purchases, control over husband’s money
and on mobility decisions, women’s sole
26 The Journal of Family Welfare
decision making power is low. Decision
taken jointly is higher in case of visiting
friends and relatives while proportion
of others is higher in large household
purchases.
TABLE 1
Percentage distribution of women by their status in
decision-making
Self Jointly Others
Control over spending 22.17 57.07 20.76
Own health 24.31 34.12 41.57
Large purchase 5.58 41.48 52.93
Small purchase 27.03 26.88 46.09
Mobility 7.54 46.42 46.04
Husband's money 5.55 59.59 34.87
Figure 1 shows the utilisation of health
services by those women who have sole
authority in household decision making
indicators. The figure depicts that of total
women having sole decision-making
power, health seeking behaviour was
found to be higher in antenatal care
indicators. A woman with 3 ANC visits
is 52.4 percent followed by immunisation
(39.61%), 38.7 percent women going for
institutional delivery and 37.9 percent
women is assisted by health professionals
during delivery.
 From the above it is clear that women
although have the sole decision-making
power have not fully utilised health care
services. This implies that other many
factors limit the utilization of maternal and
child health services in developing countries
including its availability, accessibility, quality,
and characteristics of users. These may
include distance to health care services,
cost of services, quality of services, and
technical qualification of health practitioners,
socio-economic status of the household,
and individual and women’s autonomy
in household decision-making. Hence,
for a proper understanding of the factors
influencing MCH utilisation there is a
need to investigate the influence of socio-
economic and demographic factors along
with autonomy variables on utilisation of
MCH services. For this, first we have to see
the likelihood to utilise MCH services by
decision-making as well as socio-economic
status of women which is presented below.
U t i l i s a t i o n of MCH services by
Autonomy and Socio-economic status
Tables 2 and 3 show the rate at which
women use maternal and child health
services by their autonomy and socio-
economic characteristics. Table 2 depicts
that more women having sole authority
in various household decision-making
indicators utilise MCH services than those
women whose decisions are taken jointly
or by others.
TABLE 2
Decision-making status of women and propensity to
use MCH services
Decision- Antenatal Place of Delivery Immuni-
making on care Delivery care sation
Control over spending
Self 15.49 33.67 34.01 35.14
Jointly 15.07 33.48 32.77 35.24
Others 13.59 30.28 32.64 31.39
Own health
Self 15.17 38.19 37.21 36.49
Jointly 17.15 41.51 39.71 36.47
Others 14.62 36.59 35.90 33.12
Vol. 58, No.1, June - 2012 27
Decision- Antenatal Place of Delivery Immuni-
making on care Delivery care sation
Large household purchase
Self 17.09 43.19 39.83 36.89
Jointly 16.81 39.65 38.24 36.41
Others 14.53 37.40 36.71 33.85
Daily household purchase
Self 16.17 40.67 38.81 37.33
Jointly 16.37 38.95 38.12 35.57
Others 14.86 37.30 36.42 33.47
Mobility
Self 17.89 42.61 40.75 39.24
Jointly 17.57 41.97 40.10 37.61
Others 13.29 34.67 34.40 31.85
Specifically, in the case of economic
decision-making like large or small
household purchases and in mobility
indicators utilisation of MCH services
was found to be higher. For e.g. in the
case of large household purchases, 43.1
percent of women who take decisions on
their own delivered in health institutions,
whereas it was 39.6 percent women
whose decisions were taken jointly and
37.4 percent where others take decisions
regarding the place of delivery. Similar
pattern has been observed for other
two indicators. In the case of household
decisions regarding control over
spending there is no significant difference
in the magnitude of utilisation of MCH
services where she herself takes decisions
or decisions are taken jointly. However,
a different pattern has been observed
where decisions taken with respect to
women’s own health is concerned. It is
observed from the Table that decision
to utilise MCH services is higher where
both husband and wife takes decision
jointly. Decision to utilise ANC services
is 17.1 percent where decisions are taken
jointly which is 15.1 percent for decision
taken by the respondent alone. The
same pattern is also observed in case
of institutional delivery and assistance
during delivery. For child immunization,
decision is equal in both groups. The
data presented in the Table reveals
that women’s sole decision-making in
utilisation of MCH services is quite
significant. Hence, women’s autonomy
becomes an important determinant of
maternal mortality and morbidity since
it has significant influence on utilisation
of the MCH services.
Socio-economic factors also influence
utilisation of health care services. The
percentage of women using such services
by their socio-economic characteristics
is given in Table 3. It was found that
maternal and child health care varies
directly with wealth quintile of the
household. The proportion of women
utilising MCH services has been found
to be higher among higher economic
group and systematically declines to
lower economic class. For e.g. women
with antenatal care is 6.0 percent in
poorest quintile, 8.8 percent for poor
and increased to 22 percent in the
richest quintile. The same pattern is
also observed in case of other health
care indicators. Likewise women whose
husband is in the better occupational
profile (skilled) are more likely to go
for maternal care utilization compared
to women whose husband is in manual
or in agricultural occupation. These
results clearly depict that economic
factors are quite significant in influencing
utilisation of health services. Unlike other
two economic indicators, there exists
an inverse relation between utilisation
of MCH service and work status of
women. Now coming to the demographic
characteristics which includes age and
birth order. From the Table it is clear that
more women in the reproductive age
group and having first birth are utilizing
health services. More women in 25-34 age
group avail ANC and immunisation than
women in other age groups.
28 The Journal of Family Welfare
TABLE 3
Socio-economic status of women and propensity to
use MCH services
Indicators
Antenatal Place of Delivery Immuni-
care Delivery care sation
Economic Indicators
Currently working
No 16.61 42.23 40.46 35.98
Yes 13.32 30.11 30.53 32.79
Husband's Occupation
Skilled 23.59 56.82 53.3 44.65
Manual/
agriculture 12.77 32.17 31.86 31.57
Wealth Quintile
Poorest 6.05 12.72 13.8 20.29
Poor 8.82 23.51 23.75 26.44
Middle 14.2 39.24 39.03 37.08
Rich 21.65 57.87 55.64 45.15
Richest 37.86 83.66 76.55 59.19
Demographic
Indicators Age
15-24 14.67 40.13 39.35 32.33
25-34 17.22 39.8 38.3 38.82
35+ 11.37 24.94 24.26 26.52
Birth Order
1 18.77 56.98 54.16 43.56
2 20.59 45.33 43.6 40
3 15.42 29.46 29.85 33.05
4+ 7.13 16.45 16.95 21.38
Social Indicators Caste
SC 11.06 32.95 32.65 32.53
ST 9.0 17.7 17.93 26.24
OBC 15.51 37.75 37.09 32.95
Others 21.6 52.56 49.4 43.31
Respondent’s education
No 7.56 18.41 19.43 21.78
Primary 13.78 37.42 37.12 37.64
Secondary+ 27.62 67.35 62.91 52.48
Husband's education
No 7.58 17.98 19.13 21.59
Primary 12.08 31.46 30.82 32.28
Secondary+ 3.27 51.93 49.47 43.13
Place of residence
Urban 26.61 67.47 62.41 46.88
Rural 11.92 28.89 29.09 31.01
 Likewise women in 15-24 age group
are more likely to visit health institutions
for delivery care compared to other age
groups. More women who give birth to
their first child utilise health services,
this declines in higher birth order. This
indicates that older women with more
number of children are less likely to use
health care services. Women who belong
to lower caste with little education are
less likely to use MCH services. Women
from lower socio-economic status have
less exposure to the outside world, and
consequently more traditional complacency
about their health condition, as well as
lack of knowledge about illnesses. The
poor are also more likely to encounter
other constraints, such as apathy and lack
of concern from health care providers
and corrupt practitioners, inhibiting their
access to, and utilization of services. In
contrast, those from the higher socio-
economic strata have both more exposure
to outside world and more resources to
access services. Hence, in this context it can
be argued that poverty interplay with lack
of awareness, knowledge, cost of services
etc. are constraints to utilisation of health
care services.
The rural-urban distribution of
utilisation of MCH services shows that the
proportion of women utilising maternal and
child health services is higher in urban area
than in rural area. This indicates women
in urban areas have more access to health
services compared to rural women.
Physically, in rural areas, because of
the lower accessibility of modern health
care services near their homes, lack of
transportation, costs of transport, and
difficulty of walking for hours to the health
facilities, women and children in rural area
are more likely to lag behind those from the
urban strata in the utilization of services.
The bi-variate relationship between
the use of MCH services and various
characteristics of women indicates that
Vol. 58, No.1, June - 2012 29
overall, women having decision making
power, education, social status, income,
urban residence, age, birth order etc. are all
positively related to health care utilization
with the exception of women who are
currently employed.
Relationship between women’s autonomy
and their socio-economic status on MCH
care
The analysis in this section focuses on a
set of outcome measures that contribute to
both maternal and child health: utilization
of antenatal care during pregnancy, place
of delivery, delivery care at childbirth, and
immunization after birth.
Tables 4 shows the results of logistic
regressions with each of the four health
care measures as outcomes and with
women’s autonomy indices and socio-
economic indicators as independent
variables for the state. Two separate models
were run for each of the outcome measures.
The first model controls for the influence of
autonomy indicators on utilisation of health
care services, while the full model adds
the socioeconomic background variables
of women to examine whether the effects
of the autonomy variables are influenced
by the socio-economic variables or they are
independent from such influences.
Antenatal care and its relation to women’s
autonomy & socio-economic characteristics
In the restricted models (Model 1) which
contain indices of women’s autonomy,
except women’s final say on own health
care, all other indicators have a significant
positive association with the likelihood
of using antenatal care. In the full model,
after controlling for socio-economic indices,
it has been found that women taking
decision in daily household purchases are
more likely to use ANC services. Model-2
shows that except for husband’s occupation
and education other characteristics of
women are significantly associated with the
likelihood of antenatal care.
Institutional delivery and its relation to
women’s autonomy & socio-economic
characteristics
From the models in Table 4, it is evident
that women’s sole and final say on all
the decision making variables have a
strong positive association with the level
of institutional delivery obtained. More
specifically, women who can make the final
decision alone on how to spend money
are more likely to go for institutional
delivery than women who do not have a
final say (Model 1). Decisions taken jointly
in large and daily household purchases
also have a significant impact in utilising
delivery facilities in both models (1& 2).
In the full model (Model 2), the autonomy
indicator like large household purchases
and decisions on own health care have
significant association with institutional
delivery. The socio-economic characteristics,
except for husband’s occupation, is
significantly related to utilisation of MCH
services.
Delivery care and its relation to women’s
autonomy & socio-economic characteristics
Assistance received during delivery
(health professionals like doctor/nurses)
is strongly influenced by the autonomy
indicators like those who have final say
on control over spending, decision on
daily household purchases and who takes
decision to move to friends and relatives.
At the same time decisions taken jointly
regarding respondents own health have a
significantly greater influence on use of pre-
natal services. However, after controlling
for other socio-economic and demographic
indicators, except decision to spend on
large household purchases and in mobility
indicators, other indicators loose their
significance.

TABLE 4
Determinates maternal and child health care utilization
(Odds Ratio from Logistic Regression)
Ante-natal care Place of Delivery Delivery care Immunization
Indicators Restricted Full Restricted Full Restricted Full Restricted Full
Model Model Model Model Model Model Model Model

Autonomy Indicators
Decision On control
over spending(Self)
Jointly 0.781*** 0.919 0.771*** 1.008 0.798*** 0.999 0.817 0.974
Others 0.775*** 1.049 0.707*** 1.221** 0.797*** 1.303*** 0.572*** 0.764
Own health care (Self)
Jointly 1.108 1.095 1.059 0.869** 1.139** 0.973 0.901 0.795
Others 1.03 1.14 0.891** 1.04 0.874** 0.981 1.04 1.013
Large household
purchase (Self)
Jointly 0.96 0.847 0.857* 0.553*** 0.931 0.685*** 0.943 0.887
Others 0.791** 0.797* 0.745*** 0.565*** 0.851* 0.732*** 0.79 0.754
Daily household
purchase (Self)
Jointly 1.034 1.132 0.894** 1.034** 0.837*** 0.947 0.728*** 0.682***
Others 1.176** 1.205** 1.03 0.981 0.962 0.902 1.085 0.972
Mobility (Self)
Jointly 1.087 1.058 1.049 1.138 0.978 1.023 1.489** 1.695***
Others 0.786** 0.875 0.756*** 0.895 0.717*** 0.824** 1.061 1.261

30 The Journal of Family Welfare

 Ante-natal care Place of Delivery Delivery care Immunization
Indicators Restricted Full Restricted Full Restricted Full Restricted Full
Model Model Model Model Model Model Model Model

Socio-economic Indicators
Respondent’s education (None)
Primary 1.415*** 1.591*** 1.377*** 1.216
Secondary+ 1.639*** 2.139*** 1.82*** 1.819***
Husband's education (None)
Primary 1.049 1.311*** 1.139* 1.002
Secondary+ 1.083 1.10761 1.109 1.188
Caste (SC)
ST 0.87 0.44*** 0.580*** 0.538***
OBC 1.261*** 1.079 1.093 0.723**
Others 1.16 1.088 1.045 0.969
Mass Media (No)
Yes 0.905 1.221*** 1.384*** 1.179
Currently working (No)
Yes 1.182* 1.433*** 1.440*** 0.908
Husband working (No)
Yes 1.33 0.898 0.801 1.884
Wealth Quintile (poorest)
Poor 1.207* 1.612*** 1.546*** 1.217
Middle 1.819*** 2.648*** 2.595*** 1.803***
Rich 2.343*** 3.574*** 3.551*** 2.069***
Richest 3.345*** 11.406*** 5.986*** 3.256***
Age (15-24)
25-35 1.364*** 1.193*** 1.122** 1.336**
35+ 1.561*** 2.442*** 2.061*** 1.922**
Birth order (1) 0.824*** 0.706*** 0.744*** 0.818
Place of residence
(Urban)
Rural 0.770*** 0.537*** 0.653*** 1.221
*** <1%; **<5%; *<10% level of significance

Child immunisation and its relation to
women’s autonomy and socio-economic
characteristics
In case of child immunization, indicators
like how to spend money on daily
household purchase and decision to visit
friends and relatives has a significant
impact on child immunization. Children
of women who have the final say (either
jointly with partner/others) in decisions
on day-to-day household purchases and of
visiting relatives or families are more likely
to receive all immunisation. Unlike other
indicators decision on own health care and
on large household purchases does not
influence utilisation of services. In the full
model after controlling for other factors, it
is noticed that decisions taken jointly on
daily household purchases and decision
on mobility influence immunisation.
Occupation of women as well as her
husband does not have any significant
influence on utilisation of MCH services.
Similarly, the likelihood that the child is
getting full immunization is significantly
higher in higher economic class.

Vol. 58, No.1, June - 2012 31

Discussion and Conclusion
Direct measures of women’s position
did exert a positive influence on utilisation
of health care services. Women having a
say in household spending are positively
and significantly related to utilization of
health care services. The reason may be
that by control over spending a woman
is able to pay for the assistance of a
medical professional without having to
ask her husband for money. However, the
explanatory power of the decision-making
variables gets reduced after introducing the
socio-economic and demographic variables
in the model. Among the five variables
that measured women’s autonomy in the
household, decision on large household
purchases significantly influences utilisation
of MCH services even in the full model.
The reason may be that those who have the
decision on large household purchases have
some control and access to more resources.
However, freedom to go out of the house
did not significantly influence utilization of
health services in the full model, perhaps
because freedom of movement by itself did
not grant greater autonomy.
The socio-economic and demographic
variables are highly significant and
consistent predictors of health seeking
behaviour of women in India. The strongest
influence is exerted in all the indicators
except caste and husband’s occupation in
most of the maternal and child health care
services. It is evident from the results that
women who have some education are more
likely to utilize maternal health services
than women who have no education.
Likewise women belonging to higher
wealth quintile are about two to five times
more likely to utilize MCH services and it is
11 times in the case of institutional delivery.
This study reinforces the importance
of education and income as important
determinants of health care utilisation.
Residing in urban area enhances the
likelihood of using maternity services.
However, the lower utilization in rural
area can be attributed to lack of availability
and accessibility of facilities. Birth order
32 The Journal of Family Welfare
has a significant and consistently negative
relationship with women’s health seeking
behaviour. This may be attributed to
the confidence that comes with prior
experience associated with a pregnancy
or the pressure of child care. However,
husband’s occupational status does not
have a relation with health care utilization.
The reason may be due to ease and
adequate availability of health care facilities
women do not find the need for husband’s
support for utilizing such services.
The study shows that except decision
on own health care other autonomy
indices significantly related to use of
health services. The results of the study
suggest that not all dimensions of women’s
autonomy are important predictors of
health-seeking behaviour during pregnancy,
childbirth, and child immunization. The
impact of autonomy indicators changes by
the health outcomes and after including
the socio-economic indicators in the
model some of the indicators lost their
significance.
The results reveal that women who are in
socio-economically advantageous position
are much more likely to use MCH services.
The most important result from this analysis
on health-seeking behaviour is that several
socio-economic characteristics, particularly
education of the women as well as economic
status of household have strong positive
association with health-care utilization.
Like education, women living in urban area
are more likely to use maternal and child
health care services particularly institutional
delivery as well as antenatal care.
Although women’s autonomy indicators
in some cases influence the utilisation
of maternal and child health care, but
health-care seeking behaviours are more
strongly affected by socio-economic factors.
The effects of autonomy indicators are
statistically significant in some cases, but
most after including the socioeconomic
indicators in the model, the statistical
significance is attenuated or becomes
weaker. Hence, it can be said that health
seeking behaviour of women not only
explained by autonomy indices, socio-
economic factors play a significant role in
utilising maternal and child health services.
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