Utilization of maternal health care services in South India

In this study we examine the patterns and determinants of maternal health care use across different social setting in south India: in the states of Andhra Pradesh, Karnataka and Tamil Nadu. We use data from the National Family Health Survey (NFHS) carried out during 1992-93 across most states in India. The study focuses on most recent births to evermarried women that took place during the four years prior to the date of the survey. We have used logistic regression models to estimate the effect of covariates on the utilization of maternal health services viz., antenatal care, tetanus toxoid vaccine, place of delivery and assistance during delivery. The study indicates that determinants of maternal health care services are not same across states and for different maternal health care indicators. Although illiterate women were less likely to use maternal health care services; there was no difference among the educated. The level of utilization of maternal health care services was found to be highest in Tamil Nadu, followed by Andhra Pradesh and Karnataka. Part of the interstate differences in utilization is likely to be due to differences in availability and accessibility among the three south Indian states. It is argued that the differential in access to health care facilities between rural-urban areas is an important factor for lower utilization of maternal health care services, particularly for institutional delivery and delivery assistance by health personnel in the rural areas of the three states. Results from this study indicate that health workers might play a pivotal role in providing antenatal care in the rural areas. JEL Classification: I 10, I 11, I 19 Key words: Utilization, Maternal health care, Reproductive health, Regional differential, Indi

Age structural transition and economic growth : evidence from South and Southeast Asia

Age structural transition is a process and a consequence of shifting age structure from a young aged population to old aged population. It is well known that economic growth in the East Asian countries was significantly contributed by demographic gift, that is decline in young aged population and increase in working aged population. However, little is known about the role of age structure changes on economic growth in the context of South and Southeast Asia. In this paper an attempt has been made to study the nature and process of age structural transition in the countries of South (Bangladesh, India and Sri Lanka) and Southeast Asia (Indonesia, Malaysia, Philippines, Singapore and Thailand). Further, this paper also attempts to study the influence of age structure changes on the economic growth in these countries. Time series analysis covering the period 1950-92 has been used for studying the relationship between age structure and economic growth, controlling macroeconomic variables such as investment share of GDP, net foreign balance, share of public consumption expenditure, inflation rate and openness. The ‘demographic bonus’ or ‘window of opportunity’ had a positive impact on economic growth in all Southeast Asian countries except in the Philippines. The South Asian countries did not perform well in terms of economic growth at the onset of ‘window of opportunity’. The results also indicate that countries that have had open economies and had excellent human capital benefited more from the “window of opportunity”. In the next 20-25 years, the window of opportunity is likely to benefit most South Asian countries if favourable policies are pursued to take advantage of this with opening up their economy. The demographic bonus will be available for another 15-20 years followed by a period of demographic turbulence in the Southeast Asian countries. There will be a faster growth in the old aged population after 15 years and stagnantion/decline in the working aged population. As the gaps between demographic indicators are narrowing among the Asian countries, the question remains whether demographic convergence will lead to economic convergence in the future. The demographic transition has given the South Asian countries an opportunity for economic convergence. However, whether that opportunity is realised will depend on whether socio-economic policies are favourable to economic growth. JEL Classification: F43, J11, J18, J21, J24 Key words: Age structure, window of opportunity, economic growth, open economy, South Asia, Southeast Asia

Adolescents Romantic Relationship: Dynamics of Parent-Child Relationship from India

Increased interest in romantic relationships is central in adolescents’ lives and has long been considered defining features of adolescence. Romantic relationships have significant influence on emotional wellbeing of adolescents. In Indian context, scientific literature on adolescent girls in romantic relationship is very minimal and studies focused upon sexuality-related issues and pre-marital sexual relationship. Due to social and cultural aspects, few adolescent girls who are involved in romantic relationship run away from home. These girls would come under care and protection under many circumstances such as child marriage, teenage pregnancy, sexual abuse, etc. The present study analyses the case reports in understanding the issues of adolescents in RR issues and the process of interventions provided. A total of 50 girls who were in RR were selected for the study Mean age is 16.34 years (SD ± 0.93) with a range of 14–18 years. About 78% were from lower socio economic status. It is important to understand their issues to provide psycho social intervention and facilitate healthy transition to adulthood. This has implication for designing intervention based on development perspective. Always adolescents in romantic relationship are under the conflict over prioritizing between their parents versus their romantic partner, when they forced to choose one

Structural changes in landholding in India : a study based on NSS data

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Morbidity patterns in Kerala : levels and determinants

This paper examines the levels, patterns, and determinants of morbidity in Kerala. This study is based on a community survey conducted in 2004, in three districts of the state namely Thiruvananthapuram, Malappuram and Kannur. The survey covers 3320 households having 17071 individuals in all age groups. Reported morbidity was captured for a period of fifteen days prior to the data of survey. Life course analysis was performed to understand the risk of morbidity at various stages, like infancy, early childhood, late childhood, adolescence, reproductive ages and old age, in relation to the impact of socio-economic, demographic and regional factors. The level of morbidity is high in Kerala. Generally, higher levels of morbidity have been observed among females, schedule castes, and schedule tribes as compared to their counter parts. Socio-economic and demographic determinants of morbidity varies both region and across various stages of life course. Females are at greater risk of morbidity than males. The risk of morbidity is significantly higher for illiterates and non-formal literate than persons with higher education. Among the important socio-economic determinants, education and SES showed a negative relationship with morbidity. The risk of morbidity for females is lower than males till the age of 34 years and thereafter it reverse. Poor are at greater risk of morbidity than the rich. Disease specific prevalence rate are computed according to the classification manual of World Health Organization. Communicable diseases are coming down in the state. However, non-communicable diseases are mounting irrespective of socio-economic conditions. Major ten diseases with their co-existing ailments were analysed in detail. Most of the diseases prevalent in Kerala warrant constant medical attention and treatment and sustained medical treatment is beyond the wherewithal of the average households. The private health care system cannot be an answer because of the high average cost of treatment. This warrants greater and sustained efforts by the State in widening the scope of public action. Key words: Health Status, Morbidity, Levels and Determinants, life Course Perspective, Kerala JEL Classification: I10, I12

Patterns and determinants of hypertension in Botswana

AIM: This study examines the patterns and determinants of hypertension in Botswana. SUBJECTS AND METHODS: In 2007, a cross-sectional survey of chronic non-communicable diseases and risk factors was conducted by the Ministry of Health and World Health Organisation using the STEPS approach. STEP 1 was the collection of demographic data, STEP 2 was the physical measurement of the height, weight, waist and hips, and blood pressure; STEP 3 was biochemical measurements, which included the collection of blood samples. A nationally representative sample of 4003 individuals aged 25–64 years was included for analysis. RESULTS: From a total sample of 4003 respondents, the national prevalence of hypertension was estimated to be 16.9 % (9.9 % for males versus 18.9 % for females). Logistic regression analysis indicated a positive association between gender and hypertension prevalence, with females (OR 1.9) more likely to be hypertensive. Hypertension increases significantly with age for both males and females. For women a high educational level and employment status were not associated with hypertension. Meanwhile, of all the behavioural risk factors, obesity was the only one with a significant association with hypertension. CONCLUSION: The implications of this study are that a reduction in obesity through a balanced diet and increased physical activity will have far-reaching results in lowering hypertension. Botswana’s health system should place greater emphasis on the detection of hypertension at early ages and create awareness programmes for both the general population and health personnel with respect to the detection, treatment and control of hypertension

Intimate partner violence and contraceptive use in India: the moderating influence of conflicting fertility preferences and contraceptive intentions

Several studies report that women exposed to intimate partner violence (IPV) are less likely to use contraception, but the evidence that violence consistently constrains contraceptive use is inconclusive. One plausible explanation for this ambiguity is that the effects of violence on contraceptive use depend on whether couples are likely to have conflicting attitudes to it. In particular, although some men may engage in violence to prevent their partners from using contraception, they are only likely to do so if they have reason to oppose its use. Using a longitudinal follow-up to the Indian National Family Health Survey (NFHS-2), conducted among a sample of rural, married women of childbearing age, this study investigated whether the relationship between IPV and contraceptive use is contingent on whether women’s contraceptive intentions contradict men’s fertility preferences. Results indicate that women experiencing IPV are less likely to undergo sterilization, but only if they intended to use contraception and their partners wanted more children (Average Marginal Effect (AME)=−0.06; CI=−0.10, −0.01). Violence had no effect on sterilization among women who did not plan to use contraception (AME=−0.02; CI=−0.06, 0.03) or whose spouses did not want more children (AME=−0.01; CI=−0.9, 0.06). These results imply that violence enables some men to resolve disagreements over the use of contraception by imposing their fertility preferences on their partners. They also indicate that unmet need for contraception could be an intended consequence of violence