This study aimed to assess empirically the influence of individual and community (neighbourhood) factors on the use of maternal health care services in India through three outcomes: utilization of full antenatal care (ANC) services, safe delivery and utilization of postnatal care services. Data were from the third round of the National Family Health Survey (2005-06). The study sample constituted ever-married women aged 15-49 from 29 Indian states. Multilevel logistic regression analysis was performed for the three outcomes of interest accounting for individual- and community-level factors associated with the use of maternal health care services. A substantial amount of variation was observed at the community level. About 45%, 51% and 62% of the total variance in the use of full ANC, safe delivery and postnatal care, respectively, could be attributed to differences across the community. There was significant variation in the use of maternal health care services at the individual level, with socioeconomic status and mother's education being the most prominent factors associated with the use of maternal health care services. At the community level, urban residence and poverty concentration were found to be significantly associated with maternal health care service use. The results suggest that an increased focus on community-level interventions could lead to an increase in the utilization of maternal health care services in India.

SummaryUsing data from India's National Family Health Survey, 2005-06 (NFHS-3), this article examines the patterns of relationship between birth order and infant mortality. The analysis controls for a number of variables, including mother's characteristics such as age at the time of survey, current place of residence (urban/rural), years of schooling, religion, caste, and child's sex and birth weight. A modest J-shaped relationship between birth order of children and their risk of dying in the neonatal period is found, suggesting that although both first- and last-born children are at a significantly greater risk of dying compared with those in the middle, last-borns (i.e. fourth and higher order births) are at the worst risk. However, in the post-neonatal period first-borns are not as vulnerable, but the risk increases steadily with the addition of successive births and last-borns are at much greater risk, even worse than those in the neonatal period. Although the strength of relationship between birth order and mortality is attenuated after the potential confounders are taken into account, the relationship between the two variables remains curvilinear in the neonatal period and direct in the post-neonatal period. There are marked differences in these patterns by the child's sex. While female children are less prone to the risk of dying in the neonatal period in comparison with male children, the converse is true in the post-neonatal period. Female children not only run higher risks of dying in the post-neonatal period, but also become progressively more vulnerable with an increase in birth order.

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Using data from two national surveys, this paper examines caste differences in infant mortality in India. We find that children from the three lower caste groups—Dalits (ex-untouchables), Adivasis (indigenous peoples), and Other Backward Classes—are significantly more likely than forward-caste children to die young. While this observation largely mirrors caste differences in socioeconomic conditions, low socioeconomic status is found to be only a partial explanation for higher infant mortality among lower castes. Higher mortality risks among backward-class children are almost entirely attributable to background characteristics. However, Dalit children are most vulnerable in the neonatal period even when all background characteristics are taken into account, whereas Adivasi children remain highly vulnerable in the post-neonatal period.Au moyen des données provenant des deux enquêtes nationales, cet article examine les différences dans la mortalité infantile par caste en Inde. Nous constatons que, par rapport aux enfants des castes élevées, ceux des trois castes inférieures, notamment les dalits (les ex-intouchables), les adivasis (peuples indigènes) et autres classes défavorisées (plusieurs castes désignées comme appartenant à un groupe défavorisé) courent un risque beaucoup plus grand de mourir jeunes. Bien que cette observation reflète largement les différences entre les castes sur le plan socioéconomique, le faible niveau socioéconomique n’explique qu’en partie le taux de mortalité plus élevé chez les castes inférieures. Les risques de mortalité des enfants des castes inférieures étaient presque entièrement attribuables aux caractéristiques des antécédents de la mère. Cependant, les enfants dalits demeurent les plus vulnérables pendant la période néonatale, bien que le risque de mortalité demeure le même que celui des enfants des castes supérieures pour la période post-néonatale. L’inverse est vrai pour les enfants adivasis : les caractéristiques des antécédents expliquent leur plus grande vulnérabilité pendant la période néonatale, mais pas pendant la période post-néonatale.

OBJECTIVES:This goal of this study was to shed light on the ecological context as a potential determinant of the infant mortality rate in nine high-focus states in India.METHODS:Data from the Annual Health Survey (2010-2011), the Census of India (2011), and the District Level Household and Facility Survey 3 (2007-08) were used in this study. In multiple regression analysis explanatory variable such as underdevelopment is measured by the non-working population, and income inequality, quantified as the proportion of households in the bottom wealth quintile. While, the trickle-down effect of education is measured by female literacy, and investment in health, as reflected by neonatal care facilities in primary health centres.RESULTS:A high spatial autocorrelation of district infant mortality rates was observed, and ecological factors were found to have a significant impact on district infant mortality rates. The result also revealed that non-working population and income inequality were found to have a negative effect on the district infant mortality rate. Additionally, female literacy and new-born care facilities were found to have an inverse association with the infant mortality rate.CONCLUSIONS:Interventions at the community level can reduce district infant mortality rates.