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

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

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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File URL: http://mpra.ub.uni-muenchen.de/45762/1/MPRA_paper_45762.pdf
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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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  1. 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.
  2. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
  3. Catharina Hjortsberg, 2003. "Why do the sick not utilise health care? The case of Zambia," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 755-770.
  4. Bijan J. Borah, 2006. "A mixed logit model of health care provider choice: analysis of NSS data for rural India," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 915-932.
  5. Joshua D. Angrist & Alan B. Krueger, 2001. "Instrumental Variables and the Search for Identification: From Supply and Demand to Natural Experiments," Journal of Economic Perspectives, American Economic Association, vol. 15(4), pages 69-85, Fall.
  6. Paul Collier & Stefan Dercon & John Mackinnon, 2002. "Density versus Quality in Health Care Provision: Using Household Data to Make Budgetary Choices in Ethiopia," Economics Series Working Papers WPS/2002-17, University of Oxford, Department of Economics.
  7. Hoyt Bleakley, 2010. "Health, Human Capital, and Development," Annual Review of Economics, Annual Reviews, vol. 2(1), pages 283-310, 09.
  8. Sisira Sarma, 2009. "Demand for Outpatient Healthcare: Empirical Findings from Rural India," Applied Health Economics and Health Policy, Springer Healthcare | Adis, vol. 7(4), pages 265-277.
  9. Lavy, Victor, 1996. "School supply constraints and children's educational outcomes in rural Ghana," Journal of Development Economics, Elsevier, vol. 51(2), pages 291-314, December.
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