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Does Distance matter for Institutional Delivery in Rural India? An Instrumental Variable Approach

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  • Kumar, Santosh
  • Dansereau, Emily
  • Murray, Chris

Abstract

Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. Distance to health facility is considered to be an important non-monetary barrier that impede utilization of health facilities. In this paper, we examine if access to health facilities affects institutional births in a resource-constrained country like India. We use Two-Stage Residual Inclusion (2SRI) and IV-Probit models to account for endogenous placement of health facilities. Our findings indicate that women living closer to health facilities have a higher probability of giving birth in health facility. An increase of one kilometer in the distance to the nearest health facility decreases the probability of institutional delivery by 4.4%. The results from policy simulation suggest that restricting the maximum distance to 5 kilometers would increase institutional delivery by 10%. Overall, our findings show that distance is an important barrier to service utilization and increasing the density of health facilities or improving transport infrastructure may be an important policy tool to improve facility-based delivery in developing countries.

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Bibliographic Info

Paper provided by University Library of Munich, Germany in its series MPRA Paper with number 45762.

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Date of creation: 01 Oct 2012
Date of revision: 01 Jan 2013
Handle: RePEc:pra:mprapa:45762

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Keywords: In-facility delivery; access; distance; India.;

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  1. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
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  8. Terza, Joseph V. & Basu, Anirban & Rathouz, Paul J., 2008. "Two-stage residual inclusion estimation: Addressing endogeneity in health econometric modeling," Journal of Health Economics, Elsevier, vol. 27(3), pages 531-543, May.
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Cited by:
  1. Masters, Samuel H. & Burstein, Roy & Amofah, George & Abaogye, Patrick & Kumar, Santosh & Hanlon, Michael, 2013. "Travel time to maternity care and its effect on utilization in rural Ghana: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 93(C), pages 147-154.

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