Structured Inequalities: Factors Associated with Spatial Disparities in Maternity Care in India.

Research on India documents considerable heterogeneity in health and health care across states. However, while regional differences are well established, factors underlying these differences have received little attention. This paper seeks to explain disparities in delivery care across districts by focusing on three factors: (1) Marriage and kinship patterns; (2) District wealth; (3) Governance and quality of services. Using data from nationally representative India Human Development Survey 2005 (IHDS) it examines the probability that the 11,905 women who had a child between 2000 and 2005 delivered in a hospital or received care from a doctor or a nurse while delivering at home. The results suggest that 47% of the variation in delivery care in India is between districts while 53% is between women within district. Although compositional differences in education and household wealth explain some of the variation between districts, marriage and kinship patterns, district wealth and governance each has a significant impact on shaping between-district variation in maternity care.