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November 2003, Vol 93, No. 11 | American Journal of Public Health 1820-1829
© 2003 American Public Health Association

PUBLIC HEALTH MATTERS

Contextual Influences on Reproductive Wellness in Northern India

Rob Stephenson, PhD and Amy Ong Tsui, PhD

The authors are with the Bill and Melinda Gates Institute for Population and Reproductive Health, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.

Correspondence: Requests for reprints should be sent to Rob Stephenson, PhD, Bill and Melinda Gates Institute for Population and Reproductive Health, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, W4508, Baltimore, MD 21205-2179 (e-mail: rstephen{at}jhsph.edu).

Objectives. There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India.

Methods. Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff.

Results. The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities.

Conclusions. Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes.




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R. Stephenson, A. Baschieri, S. Clements, M. Hennink, and N. Madise
Contextual Influences on the Use of Health Facilities for Childbirth in Africa
Am J Public Health, January 1, 2006; 96(1): 84 - 93.
[Abstract] [Full Text] [PDF]


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