In India, utilisation of basic health services has remained poor. The reasons may be low levels of household income, high illiteracy and ignorance, and a host of traditional factors. In this paper, an attempt is made to discuss the issues associated with the demand and supply of the five measures of maternity care: antenatal care, blood pressure check up, place of delivery, use of trained help at the time of delivery and postnatal care. Econometric analysis is undertaken to find out the determinants of the use of reproductive health care services among rural Indian households. Rural data from 32,000 households belonging to 1765 villages across all parts of India was collected by the NCAER in 1994. The multi-model survey was conducted both at the national and state level. The analysis pertains to 7635 women in the reproductive age group who delivered a child in the year before the survey. The focus on the role of education, information and economic factors as determinants of health care accessibility and their utilisation is the speciality of this analysis. Analysis shows that education and information variables significantly increase the utilisation rates for prenatal, child delivery and postnatal health care. Women with primary education are more likely to use maternal health services as compared to illiterate women, even after controlling for income and health care supply factors. Exposure to media increases the probability of reproductive health care utilisation. Economic factors such as wages and income are important only for the utilisation of child delivery services. Access to locally available health services significantly increases maternity care use. An important health care facility in this respect has been the village level ICDS centre. Further, probit regression analysis is used to examine the impact of individual, household and community level variables on the above choices of reproductive health care.
This paper first presents evidence to show that in recent years there has been a substantial fall in fertility among illiterate women in India. Subsequently, using the data from the Human Development Profile Survey of 1994, it shows that child schooling among illiterate parents is inversely related to family size and positively related to contraceptive use. By connecting these two pieces of evidence, the paper argues that fertility is falling and child schooling is rising among illiterate couples because of the quantity-quality trade-off. The detrimental effect of family size on child schooling is found to be more severe on female children and on the first-born of either sex. Perhaps this is because when family size is large, these children are either not sent to school at all or withdrawn early, to supplement the family income or to look after the younger siblings. Consequently, it is argued that the first female child would particularly stand to gain from declines in fertility.
This paper examines disparities by social group in educational and economic indicators in India and looks for inter-state variations in these. Data from the 1994 NCAER-HDI survey in rural India reveals that differentials in enrolment persist in most cases even when controlled for parental factors such as education and income indicating current direct effect of social group membership. The degree of disparity in social group differentials in economic indicators also varies across states, however the pattern is different. The regional pattern found in Hindu/Muslim educational disparities is not seen in economic conditions. Overall, the results show that though there are disparities among social groups in India, these are not uniform across states, either in magnitude or in direction, and in a few cases go against common perceptions. The study calls for assessments of social development programmes and movements in various states to see why the disparity has narrowed in some states but not in others.
In this study, an attempt has been made to examine the determinants of health status and curative health care of children, adults and the elderly in rural India using the NCAER-HDI (Human Development Indicator) national-level survey data for 1994. Health status is defined in terms of illness prevalence rate and functional disability based measures. Descriptive evidence on the measures of morbidity and choice of health care shows that there is considerable variation across the socio-economic and demographic attributes of individuals and households. The household demand framework is used to specify the reduced-form health status and curative care functions. These functions are estimated using maximum likelihood probit, tobit and multinomial logit methods. The results indicate a U-shaped relationship between age and morbidity. Both education and income exert a negative impact on morbidity measures used in this study. An interesting result is the significant negative effect of smoking on adult and elderly morbidity. Morbidity is found to be higher among the scheduled caste and scheduled tribe population. The study also sheds light on the effect of other household and village infrastructure variables on the measures of morbidity. The estimates of the multinomial discrete choice model of curative health care show that the real choice in rural India is between private health care and other types of health-care facilities. Primary-level education, household income, and village-level infrastructure and amenities are found to increase the probability of choosing private health care over any other type of facility.
In rural India access to education could act as a catalyst to change. Persons acquiring education could break through some of the social and cultural norms associated with certain occupations. However, access to education and the capacity to use it for economic betterment could differ by caste and religion. In independent India, social policies such as the reservation of seats in higher education and jobs in the public sector were intended to help break some of these entry barriers for communities facing centuries of social exclusion and discrimination. The focus of this paper is on the premium on income associated with educational investment and how this varies with ethnic groups. The probit regressions indicated that education, even at the primary level, increased the probability of obtaining a highly coveted salaried job. A ‘circle of contacts’, through other family members engaged in such jobs, also increased access to a salaried job. Educational attainment, even at very low levels, was a definite route out of poverty for the Scheduled Caste and Tribe households. Aided by the reservation policy, these communities were able to obtain salaried jobs and reap high returns to education. However, when forced to undertake self-employed activities in non-agriculture they did not fare well.
