title: Contextual influences on reproductive health service use in Uttar Pradesh, India.
abstract: This study examines the determinants of the use of four types of reproductive health-care services in Uttar Pradesh, India: contraceptive services, antenatal care, delivery in a medical institution, and services dealing with reproductive tract and sexually transmitted infections. The analysis uses a multilevel modeling strategy to assess the presence of household- and community-level variation in service use. The influence of community-level characteristics and reproductive health-care service attributes on service use is examined. The results highlight strong community-level influences on service use, although the type of community effect varies by service type. The role of some individual and household factors in determining a person's use of services is mediated by the characteristics of the community in which the individual lives. The results demonstrate the need to look beyond individual factors when examining health-care-seeking behavior, and illustrate that there is no singular "community" effect on service use.
authors.affiliation: Bill and Melinda Gates Institute for Population and Reproductive Health, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2179, USA. rstephenson@jhsph.edu
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
authors.forename: Amy Ong
authors.initials: AO
authors.lastname: Tsui
mesh_terms: D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior / Q000208:ethnology; D003466:Cultural Characteristics; D003695:Delivery of Health Care / Q000458:organization & administration; D005191:Family Characteristics / Q000208:ethnology; D005260:Female; D005783:Gender Identity; D006297:Health Services Accessibility; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D034121:Reproductive Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires