While health care services are increasingly being seen as a major proximate determinant of decreased mortality in a population, it also seems to be the case that the mere provision of services does not lead to their better utilization. However, in general, it is difficult to explore differences in utilization because the availability of services itself varies so greatly. This report presents the results of a study in India of two distinct regional groups of similar socioeconomic status, residing in the same locality and, therefore, theoretically exposed to the same health services. Both groups share a strong faith in modern medicine (especially if it is obtained from a private practitioner) for the treatment of most common illnesses. However, important cultural differentials exist in the medical services sought for childbirth and in the treatment of morbidity in children of different ages and sexes. These cultural commonalities and differentials are described, their possible causes--primary among these being the status of women--explored, and some policy recommendations made.
PIP: While health care services are increasingly being seen as a major proximate determinant of decreased mortality in a population, it also seems to be the case that the mere provision of services does not lead to their better utilization. However, in general, it is difficult to explore differences in utilization because the availability of services itself varies so greatly. This report presents the results of a study in India of 2 distinct regional groups of similar socioeconomic status, residing in the same locality and, therefore, theoretically exposed to the same health services. Both groups share a strong faith in modern medicine (especially if it is obtained from a private practitioner) for the treatment of most common illnesses. The treatment of illness episodes according to ethnic origin, type of illness, and age in Uttar Pradesh and Tamil Nadu, 1985-86 are shown in tabular form; as is the distribution of living children according to immunization status in the same 2 places for the same years. However, important cultural differentials exist in the medical services sought for childbirth and in the treatment of morbidity in children of different ages and sexes, based primary on the status of women. Sample households believed in antibiotics, particularly injectables. Preventive vaccinations are mistrusted and feared. The figures for the acceptance of at least 1 dose of triple antigen are low. The numbers of children who receive the full recommended 3-dose course has fallen sharply. According to the 1979 Survey of Infant and Child Mortality, 94% or rural Uttar Pradesh births were delivered by untrained personnel, in rural Tamil Nadu, 50% of births were delivered by untrained personnel. The women will accept only a trained doctor for delivery, or an untrained neighbor or helper. The usual sex differential in child and infant mortality, with boys having an advantage, exists in much of South Asia. There is a sex differential in health care. In Matlab, Bangladesh, when free treatment of diarrhea was offered, in spite of the fact that incidence levels of diarrhea were nearly equal, male children were more likely than females to be brought for treatment.