ArticleGlobal health action2018
Heterogeneities in utilization of antenatal care in Uttar Pradesh, India: the need to contextualize interventions to individual contexts.
Article in Global health action, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Article
- Reproductive health seeking behaviour and its determinants in Indian women-a systematic review and meta-analysis.Frontiers in reproductive health · 2026Review
- Article
- Associations of antenatal care visit with utilization of institutional delivery care services in Afghanistan: intersections of education, wealth, and household decision-making autonomy.BMC pregnancy and childbirth · 2022Article
- The role of evaluation in iterative learning and implementation of quality of care interventions.Global health action · 2021Article
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Authors and funding
7 authors.
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Abstract
backgroundThis paper explores the heterogeneities in antenatal care (ANC) utilization in India's most populated state, Uttar Pradesh. Taking an intersectionality lens, multiple individual- and district-level factors are used to identify segments of any antenatal care usage in Uttar Pradesh Objective: This paper seeks to understand the multilevel contexts of ANC utilization. The planning and programming challenge is that such knowledge of contextual specificity is rarely known upfront at the initial stages of planning or implementing an intervention. Exploratory data analysis might be needed to identify such contextual specificity.
methodsTree-structured regression methods are used to identify segments and interactions between factors. The results from the tree-structured regression were complemented with multilevel models that controlled for the clustering of individuals within districts.
resultsHeterogeneities in utilization of any ANC were observed. The multiple segments of ANC utilization that were developed went from a low utilization of 23.7% for respondents who were not literate and did not have home ownership to a high of 82.4% for respondents who were literate and at the highest level of wealth. Key variables that helped define the segments of ANC utilization include: woman's literacy, ownership of home, wealth index, and district-level sex ratio. Based on the multilevel model of any ANC utilization, cross-level interactions also were obtained between sex ratio and ownership of home as well as between sex ratio and literacy. Increases in sex ratio increased the influence of ownership of home on any ANC, while increases in sex ratio reduced the impact of woman's literacy on receiving any ANC.
conclusionWe argue that a focus on heterogeneous segments of utilization can help build knowledge of the mechanisms that underlie inequities in maternal health utilization. Such knowledge of heterogeneity needs to be incorporated in contextualizing interventions to meet a variety of recipients' needs.
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