Reproductive health welfare index: Implications for governance of reproductive health services in India

This research was done in India to measure the connect between providers of reproductive health services and clients on quality of care parameters. The research identified the segments of clients on the basis of their perceptions on quality of care parameters with respect to public and private service providers.

The research was secondary in nature. It included analysis of data collected by International Institute for Population Sciences and John Hopkins University as a follow up study to the 1998-1999 National Family Health Survey in India. The sample consisted of 6303 women. It consisted of 2666 women from states of Bihar, 1117 from Maharashtra and 1520 for Tamil Nadu. To establish the level of connect between providers of reproductive health services and clients, Reproductive health welfare index (RHWI) was constructed. The index is based upon the perceptual associations with quality of care parameters, namely; proximity, doctor’s availability, short waiting time, availability of medicines, cleanliness of facility, staff’s treatment of client and provision of privacy, affordability of services and effectiveness of treatment. To arrive at the segments of clients, cluster analysis was done. Thereafter discriminant analysis was performed to establish the differences among clusters. Discriminant analysis was done on the basis of RHWI scores with respect to various quality of care parameters.

Based upon the above analysis, three segments of clients namely beneficiary, adjusted, and neglected & marginalized were arrived at. The analysis suggests that there is cognitive inequality in the delivery of reproductive health services. The inequality is reflected in discriminant analysis. This suggests that there is need to incorporate cognitive justice in governance of reproductive health services in India. It is implied here that to ensure cognitive justice, policy makers need to give equal importance to the segments of beneficiary, adjusted and neglected & marginalized.