Social Demographics and Health Achievements: An Ecological Analysis of Institutional Delivery and Immunization Coverage in India

The National Rural Health Mission of India was expected to have two broad kinds of impacts on institutional delivery and immunization coverage. First, to significantly increase institutional delivery and immunization coverage levels across all districts and, second, to enhance equity by reducing utilization gaps between districts with higher and lower share of marginalised population. This paper adopts a lens of social demography and presents an ecological analysis of poor performing districts in nine high focus States of India. We find that between year 2007-08 and 2012-13 there has been considerable progress in institutional delivery across all the districts but improvements in full immunization coverage has been slow and many districts are failing to sustain progress in immunization coverage. Econometric analysis reveals that districts with higher shares of Muslims display slowest progress. The association is robust even in models adjusted for district-level clustering. Districts with greater availability of specialists in public health facilities have a favorable impact on institutional births whereas female literacy levels have significant influence on immunization. In concluding, we discuss the need for policy debiasing as more than a uniform approach is necessary to facilitate rapid progress in immunization across districts.

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