BackgroundTwo decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care.MethodsSecondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3) carried out during 2007–2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes – Institutional delivery, antenatal care (ANC), and use of modern contraception – and selected intermediary and structural determinants of health using multiple logistic regression.ResultsInequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence.Discussion and conclusionsPoverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste) has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic education and infrastructural development to begin to remove the structural causes of non-use of maternal health services.

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AcknowledgementsThe research which led to this publication was financed by the Bill and Melinda Gates Foundation under the broader project of AG-WATSAN Nexus Project undertaken by the Center for Development Research (ZEF) of the University of Bonn, Germany. The authors thank the Indian Institute of Public Health Gandhinagar for their collaboration during field research. We thank all the field assistants and supervisors for their excellent work during data collection and database management. The authors also thank Dr. Bhavini Shah and the team of lab technicians at Supratech Laboratory for carrying out the strenuous task of testing the microbiological quality of our water samples. AbstractThe ever-growing population of India, along with the increasing competition for water for productive uses in different sectors -especially irrigated agriculture and related local water systems and drainage -poses a challenge in an effort to improve water quality and sanitation. In rural and peri-urban settings, where agriculture is one of the main sources of livelihood, the type of water use in irrigated agriculture has complex interactions with drinking water and sanitation. In particular, the multi-purpose character of irrigation and drainage infrastructure creates several interlinks between water, sanitation (WATSAN) and agriculture and there is a competition for water quantity between domestic water use and irrigated agriculture. This study looks at the determinants of the microbiological quality of stored drinking water among households residing in areas where communities use different types of irrigation water. The study used multiple tube fermentation method 'Most Probable Number (MPN) technique, a WHO recommended technique, to identify thermotolerant fecal coliforms and E. coli in water in the laboratory (WHO 1993). Overall, we found that the microbiological water quality was poor. The stored water generally had very high levels of Escherichia coli (E. coli) contamination, 80% of the households had water in storage that could not be considered potable as per the World Health Organization (WHO) standards, and 73% of the households were using a contaminated water source. The quality of household storage water was largely unaffected by the major household socioeconomic characteristics, such as wealth, education level or social status. Households using surface water for irrigation had poor drinking water quality, even after controlling for ...

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have greatly supported the researchers during the design phase of the field research and in providing comments, logistical support and diagrammatic illustrations for the research output. Four detailed doctoral dissertations developed by the co-authors at ZEF form part of the background material of this study.

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