Contextual Influences on Reproductive Health Service Use in Uttar Pradesh, India

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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.

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