UTILIZATION OF HEALTH SERVICES AND RCH STATUS IN UTTAR PRADESH
Manju Rani, Government Degree College, Chhaprauli, Baghpat (U.P.), India
Ashok Kumar, Care India, Bihar, Patna, India
Ravendra K. Sharma, RMRCT (ICMR), Jabalpur (M.P.), India
Atvir Singh, Ch. Charan Singh University, Meerut (U.P.), India
Abstract
Uttar Pradesh state with a population of about 200 millions is the India’s most populous state and
accounts for 16% of the country’s population and about 9% of geographical area. The state is
divided into four distinct regions and 71 districts. The study examine the variation in the
utilization of RCH services viz. antenatal care, safe deliveries, child immunization, and
reproductive & child health status in the districts of Uttar Pradesh. The district level analysis is
carried out for all districts as recorded in DLSH-3 (2007-08). Different composite indices are
computed to study the pattern of socio-economic development, availability of health facilities,
utilization of RCH services and reproductive and child health status in the districts of Uttar
Pradesh state. All districts are ranked according to the values of these indices and GIS maps are
also prepared. The study reveals that utilization of health services and social development depicts
strong negative relation with reproductive morbidities. Overall, reproductive and child health are
highly and positively associated with utilization of RCH services, and quality of services. It
clearly demonstrates that districts having higher utilization of RCH services, better quality of
services also have relatively better reproductive and child health.
Introduction
Reproductive health issues have attained higher international visibility and renewed social and
political commitments in recent decades. After ICDP conference (1994), the concept of
Reproductive Health attracted a wide attention among academician, researchers and in
Government and NGOs’ programme and activities. It has a multidimensional sphere which
generally includes pregnancy, child birth and post partum care, breast feeding, maternal and
infant nutrition, infertility, sexual behaviour, STDs and HIV/AIDS, reproductive rights and
freedom and women’s status and empowerment.
Government of India has launched several programmes related to reproductive and child
health from time to time and updates its strategies in order to improve health status of women
and children and fulfil the unmet need of the RCH care through out the country. However,
despite of all these programme and efforts, many studies have revealed that reproductive and
child health situation in India is very panic, especially in northern states. Among the northern
states, Uttar Pradesh state has worst socio-economic and demographic indicators. A glance of
maternal and child health indicators of Uttar Pradesh shows that they are far below than Indian
average. Nevertheless a wide inter-district variation in demographic and RCH indictors is also
observed. This study is thus aimed to examine the variation in the utilization of health services
and reproductive and child health status among the districts of Uttar Pradesh.
Material and Methods
The district level analysis is done for all districts as per DLHS-3 survey. The state was divided in
to 70 administrative districts grouped in four geographical regions, namely Western Region,
Central Region, Eastern Region and Bundelkhand Region. The datasets used in the study are as
Census of India 2001 & 2011, District Level Health Survey-3, 2007-08 and Second Human
Development Report of Uttar Pradesh.
Different composite indices are computed to study the pattern of socio-economic
development, availability of health facilities, utilization of RCH services and reproductive and
child health status in the districts of Uttar Pradesh state. All districts are ranked according to the
absolute values of these indices. A composite index may encompass information for several
indicators and these indicators may be grouped into positive and negative indicators. But before
computing a composite index it needs to make them uniform, i.e. each indicator needs to be
standardized. The positive and negative indicators are standardized as:
For a positive indicator
Xi 
Vi  V min
*100
V max  V min
Where as Vi is the value of a indicator for ith district and Vmax and Vmin are the maximum and
minimum value of that particular indicator.
For a negative indicator
Xi 
V max  Vi
*100
V max  V min
But before computing a composite index, each indicator is assigned a weight, the weight for each
indicator is computed as
1
Var ( Xi )
Wi 
1
 Var ( Xi)
Finally, using these weights a composite index is computed as
Where
Xi
is
the
n
standardized value of Ci   Wi * Xi
an indicator and Wi is
i 1
the weight assigned to that particular indicator and n is the number of indicators included in the
composite index.
Results
Socio-demographic profile of Uttar Pradesh
Table 1: Socio-Economic and Demographic Characteristics of Uttar Pradesh
Variables
Sources & Year
India
Uttar Pradesh
Demographic Variables
Total Population (million)
Census (2011)
1210.1
199.5
CBR
SRS (Jan. 2011)
22.5
28.7
CDR
SRS (Jan. 2011)
7.3
8.2
TFR
NFHS-3 (2005-06)
2.68
3.82
IMR
SRS (Jan. 2011)
50
63
MMR
SRS (June 2011)
212
359
Decadal growth rate
Census (2001-11)
17.64
20.09
Sex Ratio
Census (2011)
940
908
Percentage pop.(0-6)
Census (2011)
13.12
14.90
Density
Census (2011)
382
828
Male Literacy
Census (2011)
82.14
79.24
Female Literacy
Census (2011)
65.46
59.26
Total Literacy
Census (2011)
74.04
69.72
Urbanization
Census (2011)
31.16
22.28
Social Variables
Sources: Paper 1 of Census of India, 2011;
Paper 2 of Census of India, 2011;
SRS Bulletin, January 2011; SRS Bulletin, June, 2011.
Table 2: Indicators used in the construction of Indexes
Index
Indicators used
Social development
1
Proportion of urbanization
Index (SDI)
2
Sex ratio (females per 1000 males)
3
Proportion of female literates
4
Proportion of females married before 18 yr
5
Female work participation
6
Proportion of male workers in non-agriculture
Infrastructure
Development Index
(IDI)
1
2
3
4
5
6
Proportion of houses with electricity
Proportion of houses with drinking water facility
Proportion of houses with toilet facility
Proportion of houses using LPG
Proportion of households living in pucca house
Proportion of households having BPL card
Health Infrastructure
Index (HII)
1
2
3
4
5
Proportion of villages having Sub-centre
Proportion of villages having PHC
Proportion of villages having any Doctor
Proportion of villages having ASHA worker
Proportion of villages having a Anganwadi Centre
Reproductive Health
Index (RHI)
1
Proportion of women experienced any complication during
Pregnancy
Proportion of women experienced any complication during
Delivery
Proportion of women experienced any complication during
Post-delivery
Proportion of women experienced any abnormal vaginal
discharge
Proportion of women experienced any problem related to
menstruation
Proportion of women who have any symptoms of RTI/STI
Proportion of couple who have infertility problem
2
3
4
5
6
7
Child Health Index
(CHI)
1
2
Proportion of children suffered from diarrhoea in reference
period
Proportion of children suffered from ARI in reference
period
Utilization of
Reproductive and Child
Health Services
(URCHS)
1
2
3
4
7
8
9
10
Proportion of women received full ANC
Proportion of safe deliveries
Proportion of women using any modern contraceptive
Proportion of women sought treatment for Pregnancy
complication
Proportion of women sought treatment for Post-delivery
complication
Proportion of women sought treatment for RTI/STI
symptoms
Proportion of couples sought treatment for infertility
Children received treatment/advice for Diarrohea
Children received treatment/advice for ARI
Proportion of children received full immunization
1
2
3
4
5
6
Proportion of women received ANC in first trimester
Proportion of women received Full ANC
Proportion of safe delivery
Proportion of children received full immunization
Proportion of children received Colostrum
Proportion of children Breastfeed with one hour.
5
6
Quality of Care Index
(QCI)
Table 3: Summary measures of inter-district variation in seven indexes
Measures
Minimum
Q1
Median
Q2
SDI
24.42
38.12
47.09
55.90
IDI
14.98
24.94
33.41
50.32
HII
24.07
32.99
39.69
47.75
RHI
15.19
42.46
53.34
63.19
CHI
10.83
48.01
64.51
84.96
URCHI
20.54
34.38
39.35
48.00
QCI
3.43
27.17
39.61
55.33
Maximum
IQR
Mean
SD
CV
N
75.42
17.78
46.96
11.67
0.25
70
97.38
25.39
38.58
18.14
0.47
70
68.93
14.75
40.84
10.01
0.25
70
88.69
20.73
52.59
14.88
0.28
70
96.29
36.95
64.20
20.98
0.33
70
66.94
13.62
40.44
9.73
0.24
70
77.46
28.15
40.87
16.20
0.40
70
Figure 1: Inter-district variation in seven indexes
100.00
Ghaziabad
9
80.00
60.00
40.00
20.00
0.00
SDI
IDI
HII
RHI
CHI
URCHI
QCI
Different Map showing the regional variation in different indicators
Indexes
Table 4: Rank correlation coefficient
RHI
CHI
SDI
IDI
HII
RHI
CHI
-0.07
-0.17
-0.11
1.00
0.65**
0.04
-0.06
-0.01
0.65**
1.00
URCHI
QCI
0.12
0.46**
0.26*
0.54**
** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).
Conclusion
The reproductive and child health status in the state is far below than the national average. There
are also vast differences among the districts of Uttar Pradesh in respect to social development,
reproductive and child health and utilization and quality of services. Different indices show
different results but by and large districts like Lucknow, Kanpur Nagar, Ghaziabad, Gorakhpur
and Baghpat are better off, while districts Badaun, Shrawasti, Chitrakoot, Bahraich, Gonda, and
Kushi Nagar are comparatively worst off. Some better off districts shows poor RCH status,
whereas some poor performing districts have better RCH indicators.
Overall, reproductive health and child health is highly and positively association with
utilization of RCH services, and quality of services. It clearly demonstrates that districts that
have higher utilization of RCH services, better quality of services also have better reproductive
and child health. Thus an improvement in utilization of reproductive and maternal health services
will not only reduce the reproductive morbidities, but it will also trim down the child mortality.
State Government should focus more on worst performing districts and try to improve the
availability and quality of health services.