This paper attempts to study the differentials of health service availability and uptake of services particularly for women’s health needs related to out-patient care and institutional childbirth. Understanding their various predictors, along with the issues related to geographical accessibility, in the context of the Sunderbans. The paper is constructed based on the emerging concept of mutability and the related model, suggested by Andersen (1995). Two separate regression models are built to study the impact of various predictors on out-patient care and institutional childbirth and meaningful post-estimation results are observed. The impact of geographic hardships measured through useful identifier related to physiography and means of available transportation are not viewed having any significant influence on out-patient care seeking by the women. Impact of physical accessibility is however observed in case of institutional childbirth. Proximity of informal providers may be one the reason made the women even from inaccessible areas, seeking out-patient care for ailments particularly that lasted over a month. Unlike out-patient care, institutional childbirth is found considerably low overall for Sunderbans, as the state’s rural standard, which is found further lower for the geographically inaccessible villages. This is probably attributed by the norms of beliefs of the household members regarding place of delivery, rather than any other hindrance including geographical accessibility. Best policy directives should focus on facilitating means of transportation for the population living in inaccessible parts within the Sunderbans, who continue to experience enormous hardships related to transport means, while accessing services for ill-health. Ensuring safety and efficacy of services provided by the informal providers remains as one of the major challenge for overall healthcare in the Sunderbans. Since norms related to place of childbirth might take a much longer time to get influenced, it is useful that maternal safety gets ensured through alternative arrangement made by the system that facilitates safe domiciliary childbirth in the nooks and corners of the Sunderbans.
Future Health Systems Working Paper IV, India Series, 20 pp.