Rajbhar Mamta, Mohanty Sanjay K
*International Institute for Population Sciences,Deonar,Mumbai,India.
†Department of Fertility Studies,International Institute for Population Sciences,Deonar,Mumbai,India.
J Biosoc Sci. 2017 Sep;49(5):685-709. doi: 10.1017/S0021932016000511. Epub 2016 Oct 3.
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.
本研究考察了印度北方邦各地区生殖与儿童健康（RCH）服务对生育率和儿童死亡率的影响。具体测量了国家农村卫生使命（NRHM）实施前后，产前护理、分娩医疗救助、儿童免疫接种以及现代避孕方法的使用对总生育率（TFR）、婴儿死亡率（IMR）和五岁以下儿童死亡率（U5MR）的影响。研究使用了2002 - 2004年地区级家庭调查（DLHS - 2）、2012 - 2013年年度卫生调查（AHS）以及2001年和2011年印度人口普查的数据。以地区为分析单位，根据印度人口普查数据估算总生育率和五岁以下儿童死亡率。运用描述性统计、综合指数、随机效应模型和固定效应模型以及差分模型，来了解生殖与儿童健康服务对降低总生育率、婴儿死亡率和五岁以下儿童死亡率的影响。结果表明，该邦各地区生殖与儿童健康服务的覆盖范围存在很大差异。在国家农村卫生使命实施后的时期，大多数地区安全分娩方面的改善最为显著，其次是免疫接种覆盖率和产前护理，而避孕措施的使用改善最少。各地区的相对排名随时间变化不大。2002 - 2004年，勒克瑙的生殖与儿童健康指数最高（0.442），其次是巴利亚，考沙姆比最低（0.115）。到2012 - 2013年，占西的指数最高（0.741），施拉瓦斯蒂最低（0.241）。随着时间推移，考沙姆比、乌纳奥、马霍巴、班达和哈多伊等地区在生殖与儿童健康指数方面表现较好，而巴利亚、 Gautam Buddha Nagar、坎普尔纳加尔、普拉塔普加尔和松巴德拉仍然较差。七个地区，特别是北方邦东部和西部的地区，生殖与儿童健康服务覆盖范围和人口统计结果较差。回归分析表明，生殖与儿童健康指数对降低婴儿死亡率和五岁以下儿童死亡率的影响更大，而女性识字率对降低总生育率的影响更大。混合模型的结果表明，生殖与儿童健康指数每变化10%，婴儿死亡率将下降3个百分点，女性识字率每提高10%，总生育率将下降0.2个百分点。该研究建议继续投资于女性教育和生殖与儿童健康服务，更加关注表现不佳的地区，以实现人口和健康目标。
