Towards an understanding of the multilevel factors associated with maternal health care utilization in Uttar Pradesh, India

Figures & data

Figure 1. Social Determinants of Health framework.

Table 1. Descriptive statistics for dependent and independent variables.

	Level	Mean	SD	N
Dependent variables
Pregnancy registration	Individual	0.71	0.46	5666
Antenatal care	Individual	0.51	0.50	5666
Delivery at home	Individual	0.32	0.47	5666
Independent variables
Infrastructure
Average distance of villages to district headquarters	District	34.36	4.97	49
Community health centres (numbers/10,000 population)	District	0.03	0.02	49
Primary health centres (numbers/10,000 population)	District	0.11	0.03	49
Sub-centres (numbers/10,000 population)	District	0.08	0.08	49
Demographics
Age at interview	Individual	26.64	4.65	5666
Married at 15 years or less	Individual	0.61	0.49	5666
Hindu	Individual	0.82	0.38	5666
SC/ST	Individual	0.30	0.46	5666
OBC	Individual	0.57	0.49	5666
Proportion females	District	47.64	0.93	49
Proportion SC/ST	District	21.40	6.18	49
Literacy
Can read or write	Individual	0.44	0.50	5666
Husband ever attended school	Individual	0.75	0.43	5666
Proportion of illiterates in a district	District	45.1	6.70	49
Prosperity
Own a house	Individual	0.85	0.36	5666
Own a bank account	Individual	0.89	0.32	5666
Members per room in a household	Individual	0.39	0.30	5666
Worked in the last 1 year	Individual	0.07	0.26	5666
Wealth index	Individual	0.01	3.02	5666
Access to health care & decision making
Health decisions taken by self	Individual	0.6	0.49	5666
Health care can be accessed by self	Individual	0.19	0.39	5666

Figure 2. Variations in pregnancy registration, receipt of antenatal care (A.N.C.), and delivery at home across districts.

Table 2. Variance components corresponding to the null model.

	Register	Home	Antenatal care
District intercept coefficient	0.92***	–0.88***	0.09
(standard error)	(0.06)	(0.08)	(0.07)
Variance component	0.14***	0.29***	0.18***
Chi-square	206.7	420.5	263.6

***p < 0.001.

Table 3. Multilevel models for pregnancy registration.

	B (Std. error)	Odds ratio	95% confidence interval	t-test
District-level factors
Distance	0.00	1.00	(0.99, 1.02)	0.43
	(0.01)
Proportion female	–0.03	0.98	(0.88, 1.08)	–0.49
	(0.05)
Proportion SC/ST	0.01	1.01	(0.99, 1.03)	1.50
	(0.01)
Proportion illiterate	0.00	1.00	(0.98, 1.01)	–0.35
	(0.01)
Community health centres	–4.39	0.01	(0.00, 6.74)	–1.41
	(3.12)
Primary health centres	1.58	4.87	(0.13, 176.6)	0.89
	(1.78)
Sub-centres	2.49	12.01	(2.13, 67.86)	2.90***
	(0.86)
Individual-level factors
Hindu	–0.02	0.98	(0.79, 1.22)	–0.17
	(0.11)
SC/ST	0.19	1.21	(0.99, 1.47)	1.92
	(0.10)
OBC	0.00	1.00	(0.82, 7.23)	0.03
	(0.10)
Own house	0.82	2.28	(1.85, 2.80)	7.79***
	(0.11)
Bank account	0.31	1.36	(1.11, 1.68)	2.93***
	(0.11)
Self health	0.17	1.18	(0.94, 1.49)	1.42
	(0.12)
Health alone	–0.19	0.82	(0.67, 1.01)	–1.86
	(0.10)
Read or write	0.24	1.28	(1.12, 1.46)	3.53***
	(0.07)
Any job in the last year?	0.09	1.09	(0.83, 1.45)	0.62
	(0.14)
Wedding below the age of 15	–0.18	0.84	(0.74, 0.96)	–2.63***
	(0.07)
Husband schooling	0.40	1.49	(1.26, 1.76)	4.69***
	(0.08)
Density	–0.26	0.77	(0.62, 0.96)	–2.37**
	(0.11)
Wealth index	0.03	1.03	(0.99, 1.06)	1.81
	(0.02)
Age at interview	–0.01	0.99	(0.98, 1.01)	–0.75
	(0.01)

***p < 0.01; **p < 0.05.

Table 4. Multilevel model for antenatal care.

	B (Std. error)	Odds ratio	95% confidence interval	t-test
District-level factors
Distance	–0.01	0.99	(0.97, 21.01)	–0.61
	(0.01)
Proportion female	0.32	1.38	(1.23, 21.55)	5.73***
	(0.06)
Proportion SC/ST	0.00	1.00	(0.99, 21.02)	0.51
	(0.01)
Proportion illiterate	0.01	1.01	(0.99, 21.03)	0.92
	(0.01)
Community health centres	–4.84	0.01	(0.00, 7.33)	–1.43
	(3.39)
Primary health centres	–2.61	0.07	(0.00, 3.20)	–1.40
	(1.87)
Sub-centres	2.30	9.98	(2.29, 43.54)	3.15***
	(0.73)
Individual-level factors
Hindu	–0.14	0.87	(0.72, 1.06)	–1.38
	(0.10)
SC/ST	–0.24	0.79	(0.61, 1.01)	–1.86
	(0.13)
OBC	–0.32	0.73	(0.58, 0.92)	–2.68***
	(0.12)
Own house	1.04	2.83	(2.27, 3.53)	9.15***
	(0.11)
Bank account	0.10	1.11	(0.90, 1.37)	0.95
	(0.11)
Self health	–0.07	0.93	(0.82, 1.05)	–1.18
	(0.06)
Health alone	–0.06	0.94	(0.81, 1.10)	–0.78
	(0.08)
Read or write	0.40	1.49	(1.28, 1.73)	5.17***
	(0.08)
Any job in the last year?	0.33	1.39	(1.10, 1.77)	2.73***
	(0.12)
Wedding below the age of 15	–0.34	0.71	(0.63, 0.81)	–5.22***
	(0.07)
Husband schooling	0.27	1.30	(1.15, 1.48)	4.08***
	(0.07)
Density	–0.17	0.85	(0.66, 1.08)	–1.36
	(–0.12)
Wealth index	0.10	1.11	(1.08, 1.13)	8.25***
	(0.01)
Age at interview	–0.03	0.97	(0.96, 0.98)	–5.21***
	(–0.01)

***p < 0.01; **p < 0.05.

Table 5. Multilevel model for home delivery.

	B (Std. error)	Odds ratio	95% confidence interval	t-test
District-level factors
Distance	0.05	1.05	(1.03, 1.08)	3.99***
	(0.01)
Proportion female	–0.11	0.90	(0.74, 1.08)	–1.15
	(0.09)
Proportion SC/ST	–0.04	0.96	(0.94, 0.98)	–4.31***
	(0.01)
Proportion illiterate	0.00	1.00	(0.99, 1.02)	0.33
	(0.01)
Community health centres	–2.00	0.14	(0.00, 34.19)	–0.73
	(2.74)
Primary health centres	–0.22	0.80	(0.00, 137.5)	–0.09
	(2.55)
Sub-centres	–2.62	0.07	(0.01, 0.42)	–3.04***
	(0.86)
Individual-level factors
Hindu	–0.03	0.97	(0.82, 1.15)	–0.35
	(0.09)
SC/ST	0.54	1.72	(1.35, 2.19)	4.43***
	(0.12)
OBC	0.53	1.69	(1.30, 2.21)	3.93***
	(0.13)
Own house	–0.09	0.92	(0.78, 1.08)	–1.04
	(0.08)
Bank account	–0.24	0.79	(0.65, 0.95)	–2.50**
	(0.10)
Self health	–0.02	0.98	(0.88, 1.09)	–0.42
	(0.06)
Health alone	–0.01	0.99	(0.84, 1.16)	–0.11
	(0.08)
Read or write	–0.47	0.62	(0.54, 0.72)	–6.36***
	(0.07)
Any job in the last year?	0.29	1.33	(1.02, 1.74)	2.12**
	(0.14)
Wedding below the age of 15	0.39	1.48	(1.26, 1.73)	4.87***
	(0.08)
Husband schooling	–0.13	0.88	(0.76, 1.01)	–1.84
	(0.07)
Density	–0.20	0.82	(0.65, 1.03)	–1.72
	(0.12)
Wealth index	–0.04	0.96	(0.94, 0.99)	–2.99***
	(0.01)
Age at interview	0.01	1.01	(0.99, 1.02)	1.26
	(0.01)

***p < 0.01; **p < 0.05.