Rural health facility and Institutional birth: A study in composite index formation and spatial modeling

This study examines the spatial relationship to the maternal-health-care utilization focusing on institutional births which direct related to maternal-mortality.Socio-economically weak states (Empowered Action Group)was studied. Some facility adequacy indices were prepared for the purpose using DLHS-3 data and reliability test found to be good(0.7<alpha<1.0).Inequality measures showed maximum number of districts belongs to UP and Bihar where lowest adequacy of all indices of infrastructures at PHCs. Though very uneven pattern was seen for the adequacy at HSCs. Correlation-matrix showed health personnel adequacy index were highly correlated with physical-infrastructure-index at PHC. Spatial dependence for delivery care captured the better acceptability to describe through several tests of spatial diagnosis over dependents, independents and error term. Some covariates disappeared its influence on independents once spatial-lag parameter incorporated in the OLS model like availability of doctors at PHC, proportion of SC/ST and urban population. Low infrastructure adequacy, distant health facility providing ANC/delivery care and proportion of lowest quintile have significantly reduced the probability of institutional births while receipt of 3or more ANC, connectivity of village to the health center and women literacy have encouraged.