School of Public Health

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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.

Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.

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Author: search.filters.author.Vora, Kranti Suresh

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    Predictors of maternal health services utilization by poor, rural women: a comparative study in Indian States of Gujarat and Tamil Nadu
    (Springer Nature, 2015-07-31) Vora, Kranti Suresh; Koblinsky, Sally A.; Koblinsky, Marge A.
    India leads all nations in numbers of maternal deaths, with poor, rural women contributing disproportionately to the high maternal mortality ratio. In 2005, India launched the world’s largest conditional cash transfer scheme, Janani Suraksha Yojana (JSY), to increase poor women’s access to institutional delivery, anticipating that facility-based birthing would decrease deaths. Indian states have taken different approaches to implementing JSY. Tamil Nadu adopted JSY with a reorganization of its public health system, and Gujarat augmented JSY with the state-funded Chiranjeevi Yojana (CY) scheme, contracting with private physicians for delivery services. Given scarce evidence of the outcomes of these approaches, especially in states with more optimal health indicators, this cross-sectional study examined the role of JSY/CY and other healthcare system and social factors in predicting poor, rural women’s use of maternal health services in Gujarat and Tamil Nadu. Using the District Level Household Survey (DLHS)-3, the sample included 1584 Gujarati and 601 Tamil rural women in the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between JSY/CY and other salient health system, socio-demographic, and obstetric factors with three outcomes: adequate antenatal care, institutional delivery, and Cesarean-section. Tamil women reported greater use of maternal healthcare services than Gujarati women. JSY/CY participation predicted institutional delivery in Gujarat (AOR = 3.9), but JSY assistance failed to predict institutional delivery in Tamil Nadu, where mothers received some cash for home births under another scheme. JSY/CY assistance failed to predict adequate antenatal care, which was not incentivized. All-weather road access predicted institutional delivery in both Tamil Nadu (AOR = 3.4) and Gujarat (AOR = 1.4). Women’s education predicted institutional delivery and Cesarean-section in Tamil Nadu, while husbands’ education predicted institutional delivery in Gujarat. Overall, assistance from health financing schemes, good road access to health facilities, and socio-demographic and obstetric factors were associated with differential use of maternity health services by poor, rural women in the two states. Policymakers and practitioners should promote financing schemes to increase access, including consideration of incentives for antenatal care, and address health system and social factors in designing state-level interventions to promote safe motherhood.
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    Implementation of Janani Suraksha Yojana and other maternal health policies in two Indian states: Predictors of maternal health service utilization among poor rural women
    (2012) Vora, Kranti Suresh; Koblinsky, Sally; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Poor, rural women in India contribute disproportionately to the nation's high maternal mortality ratio. In response to this problem, the Indian government launched a conditional cash transfer scheme, "Janani Suraksha Yojana (JSY)," in 2005 to increase poor women's access to maternal health care. The state of Tamil Nadu reorganized public health system resources and the state of Gujarat contracted with private providers to implement the scheme in rural areas. This study investigated the role of JSY/government assistance, and other health care sector and household factors in predicting poor, rural women's utilization of maternal health services in the two states. Health care sector factors included receipt of JSY payment, availability of a primary health center with round-the-clock services, and connection to a health facility by an all-weather road. Household factors included maternal education, paternal education, age at first birth and parity. Use of four maternal health care services was examined: adequate antenatal care, institutional delivery, private facility delivery and Cesarean section. State findings were compared and contextualized by examining health polices/practices and health infrastructure within each state. The study employed secondary data analyses using District Level Household Survey (DLHS)-3 data, with a sample of 2,267 rural women from the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between identified factors and maternal health care utilization in the two target states. Overall, Tamil women had better access to maternal health care services than Gujarati women. JSY payment predicted use of private facility deliveries in Gujarat, which incentivized use of private providers, but not institutional deliveries in Tamil Nadu where women also received cash regardless of the place of delivery. JSY payment did not predict adequate antenatal care, which was not incentivized. Access to an all-weather road predicted institutional deliveries in both states and adequate antenatal care by Tamil women. Maternal education was a significant predictor of maternal health services utilization in Tamil Nadu, while paternal education predicted such usage in Gujarat. Parity significantly predicted poor, rural women's use of all services. Implications of the findings for strengthening conditional cash transfer schemes and improving maternal health care services are discussed.