Geographic Constraint to Institutional Delivery in Rural India: An Instrumental Variable Approach

Santosh Kumar, University of Washington

In this paper, we examine if access to health facilities is a barrier to institutional birth delivery in India. Using a household- and village-level health survey, we find that women living closer to health facilities have a higher probability of in-facility births. A one kilometer increase in the distance to the nearest health facility decreases the probability of institutional delivery by 0.8%. After accounting for endogenous placement of health facilities, results of Two-Stage Residual Inclusion (2SRI) and IV-Probit models suggest that an additional travel of one kilometer decreases probability of in-facility delivery (IFD) by 4.4%. The policy simulation result suggest that, the mean probability of in-facility delivery increases when the density of health facility is increased. Overall, results suggest that geographic distance is an important barrier to service utilization and increasing the density of health facilities or improving transport infrastructure may be an important policy tool to improve in-facility delivery.