REPRODUCTIVE AND CHILD HEALTH SERVICES AND DEMOGRAPHIC CHANGE IN THE DISTRICTS OF UTTAR PRADESH, 2002-13.

This study examined the effect of reproductive and child health (RCH) services on fertility and child mortality in the districts of Uttar Pradesh. It specifically measured the effect of antenatal care, medical assistance at birth, child immunization and use of modern methods of contraception on Total Fertility Rate (TFR), Infant Mortality Rate (IMR) and Under-five Morality Rate (U5MR) before and after the National Rural Health Mission (NRHM) period. Data from the 2002-04 District Level Household Survey (DLHS-2), 2012-13 Annual Health Survey (AHS) and the 2001 and 2011 Censuses of India were used. The TFR and U5MR were estimated from the Census of India with district as the unit of analysis. Descriptive statistics, composite indices, random- and fixed-effects models and difference-in-difference models were used to understand the effect of RCH services on the reduction in TFR, IMR and the U5MR. The results suggest large inter-district variations in the coverage of RCH services in the state. During the post-NRHM period, improvement was highest in safe delivery followed by immunization coverage and antenatal care and least for contraceptive use in most districts. The relative ranking of districts has not changed much over time. In 2002-04, the RCH Index was highest in Lucknow (0.442) followed by Ballia and least in Kaushambi (0.115). By 2012-13, it was highest in Jhansi (0.741) and lowest in Shrawasti (0.241). The districts of Kaushambi, Unnao, Mahoba, Banda and Hardoi performed better in the RCH Index over time, while Ballia, Gautam Buddha Nagar, Kanpur Nagar, Pratapgarh and Sonbhadra remained poor. The RCH service coverage and demographic outcomes were poor in seven districts, particularly those in eastern and western Uttar Pradesh. The regression analyses suggest that the RCH Index exerts greater influence on the reduction in IMR and U5MR, while female literacy exerts greater influence on the reduction in TFR. The results of the hybrid model suggest that a 10% change in RCH Index would lead to a 3 point decline in IMR, and a 10% increase in female literacy would lead to a 0.2 point decline in TFR. The study suggests continuing investment in female education and RCH services with a greater focus on poor-performing districts to realize demographic and health targets.