Contextual influences on reproductive wellness in northern India.
OBJECTIVE
There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India.


METHODS
Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff.


RESULTS
The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities.


CONCLUSIONS
Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes.
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. rstephen@jhsph.edu
Rob
R
Stephenson
Amy Ong
AO
Tsui
D000293:Adolescent; D000328:Adult; D005191:Family Characteristics / Q000208:ethnology*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006694:Holistic Health; D006801:Humans; D007194:India / Q000453:epidemiology; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000208:ethnology; D017063:Outcome Assessment, Health Care; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology; D034121:Reproductive Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D012111:Residence Characteristics; D012423:Rural Health; D012749:Sexually Transmitted Diseases / Q000208:ethnology; D012959:Socioeconomic Factors; D012962:Sociology, Medical; D011795:Surveys and Questionnaires