Utilization of health services among rural women in Gujarat, India.
Vissandjee, Bilkis
1994
Abstract
Evidence from the literature has shown that factors found to influence use of health services are not limited to the characteristics of the services, but often extend to the characteristics of the users. This dissertation examined the effects of four sets of factors on use of health services among rural women living in Gujarat, India. The specific sets of factors analyzed were as follows: (1) the demographic characteristics of women; (2) the characteristics of the household in which these women lived; (3) the characteristics of the environment in which these women lived; and (4) the price and convenience of care. Data for the dissertation derived from a household survey conducted by the Aga Khan Health Services, India. A two-stage probability design was adopted to select the sample. The dissertation focused on rural married women aged 17 to 45 who had at least one child. Multiple logistic regressions were computed on cross-sectional data to assess the simultaneous influences of the four sets of independent variables on (1) use of curative services among rural women who reported an illness and (2) use of preventive services among rural women who reported a pregnancy. The reference period was 12 months preceding the survey. Four types of service were examined as outcomes of interest, namely, use of private doctors, Aga Khan Health Services centres, government health centres, and traditional healers. A central finding was that rural ill women in the research area tended to use curative services to a greater extent than pregnant women used preventive services. Other things being equal, women's education, income and kinship affiliation were significant predictors of use of service. Furthermore, the women seemed to be more sensitive to travel time to the health service and its associated costs (purdah restrictions, transportation and time costs) than direct costs of service. Other factors such as women's occupation and family structure, while associated with use of service in the expected direction, were shown not to be significant predictors of use of service. Private doctors were used predominantly by higher income women for curative purposes. Dais (traditional birth attendants) were used by pregnant women both in the lower as well as in the higher socio-economic stratum for preventive purposes. Few women used the government health centres. While the important determinants for the use of private doctors and for AKHS centres were identical, a larger number of rural women used the latter type of service. Some implications for health planning are offered, focusing on initiatives to implement health promotion and disease prevention programs in addition to increasing access to the existing health services. Avenues for future studies are provided, particularly in regard to decision-making processes reinforcing the health-seeking behavior of rural women. It is recommended that such policies and studies should consider the cultural environment in addition to the existing pluralistic health system.Other Identifiers
(UMI)AAI9501056
Subjects
Health Sciences, Public Health Sociology, Public and Social Welfare
Types
Thesis
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