Female Health Workers Research Articles

Kadın Sağlık Personellerinin Kadına Yönelik Şiddet Hakkında Bilgi Tutum ve Davranışları

Aim Violence against women is a global public health problem that has serious adverse effects on women’s physical, mental, and reproductive health. Although the health workers place the most import part of helping the victim of violence; they(specially female health workers) also have risk to be a victim of violence againt women and violence against healthworkers. In our study we try to examine the knowledge of female health workers, about violence against women and examine the experiences about violence against women or on them. Method We form a questionare for violence against women and their experiences about violence against them or vıctıms. We applied to female health workers (doctors and nurses) in our hospital at our worker health policlinic. We were performed by doctors by face to face method to the subjects. The data were recorded to statistics program and frequency, Chi-square and t-test were used for the analysis; p≤0.05 was considered as statistically significant. Results 49(46,2%) doctor; 57(53,8%) nurse were included our study. 74(%69,8) were faced a violence against them [doctors(32; 43,2%); nurses(42;56,8%)]. Being doctor or nurse make any difference to be a victim.Violence is statisticaly associated with age and working years(p=0,050;p=0,017). We ask participants that when you meet a victim what dou you do? 54(50,9%) said that they can’t face these stuation and referee to an other Professional. When suspicion and victims deny; 55(51,9%) says that they only give some numbers to call and want help. There is no association between being a victim of violence and knowing what to do to help victim. Conclusion Although health workers themselves are exposed to high-level violence, we have found that there is still a lack of information on how to approach them and the case they are facing. For this reason, in-service trainings and lessons in university should be organized .

Breast cancer screening practices amongst female tertiary health worker in Nnewi.

Breast cancer in Nigeria and other developing countries is characterized by late presentation and poor outcome due to ignorance, superstition, self-denial, fear of mastectomy, and unavailability of treatment facilities. The mortality of breast cancer in Western world is decreasing due to early detection and better management. This study aims at accessing the knowledge, attitude, and practice of breast cancer screening among female tertiary health workers. A cross-sectional descriptive study carried out using a structured, pretested, self-administered questionnaire to assess the knowledge, attitudes, and practice of breast cancer and screening methods among female health workers. The mean age of respondents was 31.70 ± 7.62 years. The level of awareness of breast cancer screening methods was high: 158 (98.75%), 127 (79.4%), and 144 (90.0%) for breast self-examination (BSE), clinical breast examination (CBE), and mammography, respectively. However, only 47 (35.9%), 36 (22.5%), and 3 (1.9%) correctly practiced BSE, CBE, and mammography, respectively. The level of education and occupation showed significant correlations with the knowledge and practice of breast cancer screening methods. Breast cancer screening still needs to be promoted to improve the attitude and practice among both health workers and general population.

Utilization of Cervical Cancer Screening and Associated Factors among Female Health Workers in Governmental Health Institution of Arba Minch Town and Zuria District, Gamo Gofa Zone, Arba Minch, Ethiopia, 2016

Background: Cervical cancer screening is a key to detect the pre-cervical cancer earlier, but it is almost not utilized in all developing countries and most cases were diagnosed at late stage of cervical cancer. The current screening level has no much effect to control cervical cancer unless addressing female health workers since they are a role model to the public. Objective: The study was conducted to assess the utilizations of cervical cancer screening and associated factors among female Health workers in Arba Minch town and Zuria woreda public health facilities in 2016/17. Methods: A facility based cross-sectional study design was conducted in Arba Minch town and Zuria district, among selected female health professions using computer generated technique of simple random sampling. The data was collected by means of self-administered questionnaires and ethical issue had been given more emphasized during data collection time. Data was entered using EPI info version 7.2.0.1 and analyzed by SPSS version 20. The associations of explanatory and outcome variables were assessed by binary logistic regression and those variables with p value of less than 0.25 were included in multivariate analysis and Statistical significant was considered with odd ratio, 95% of confidence interval and p value of <0.05. Result: About 281 of the respondents were correctly completed the questionnaire of the total respondents, only 27 (9.6%) have had cervical screening within the past three years. There was an association between service year utilization of cervical cancer screening (AOR=4.99, 95% CI: 1.36-18.10), knowledge of cervical cancer screening and utilization of cervical cancer screening (AOR 1.78, 95% CI: 1.05-3.02). Conclusion: The level of utilization of screening was low in female health workers, service year and knowledge were associated with the utilization of cervical screening. Sustaining awareness creation and sensitization of screening should be given emphasis broadly for female’s health workers to increase the number of utilization in health workers.

Barriers to health care professionals in detecting more domestic violence

Introduction. Identification of victims of domestic violence among the women using the healthcare is not sufficient. Objective. The aim of this study is to identify the barriers that prevent health care professionals in identifying domestic violence more often. Method. A questionnaire was distributed to health workers in the Health center of Kraljevo, by e-mail. Results. The study comprised 136 health care workers, 73.3% female and 26.7% male. 70.6% were doctors and 29.4% technicians. The mean age of respondents was 38.93 ± 7.7, (range 31-50), with the average 11.36 ± 7.74 years of service. The social barriers were significantly more present among female health workers (p=0.037). The most frequent answer is the lack of guidelines. This answer is significantly in correlation with professional qualification (p=0.002). The prominent institutional barriers are overwork (53.7%), lack of information about the procedures (significantly present among doctors, p=0.003), and the fear for their own safety (46.3%). Barriers associated to the health care workers themselves have the least number of responses, with limited time as the most important, followed by lack of training (44.9%) and lack of knowledge, that is significantly related to gender (p=0.002) and to qualifications (p=0.009). Women expect more authority in their work, p=0.035. Among the 4 groups of barriers, the majority of answers is related to the victims of violence themselves (43.9%), statistically more significant among doctors, p=0.004, predominantly responding that victims hide the violent behavior of their partners (65.4%). Conclusion. Provide continuous education about domestic violence and evaluation of knowledge, encourage the victims to trust the health system, raise awareness about the judgment of violence, and skillfully inform the women of resources in the community.

Overcoming Work/Family Challenges Among Female Health Workers in Selected Public Healthcare Institutions in Ekiti State

Overcoming Work/Family Challenges Among Female Health Workers in Selected Public Healthcare Institutions in Ekiti State

Public Healthcare Sector: Is Losing Its Importance in Rural Tamil Nadu?

In India, though Tamil Nadu is one of the best performing states in health, it is losing its importance in many areas. There is no specialist in Community Health Centres (CHCs) functioning in Tamil Nadu; all specialist posts are vacant, though there is excess number of doctors in primary health centres (PHCs) and enough number of SCs (sub-centres), PHCs and CHCs. The number of PHCs functioning without lady doctors is also the maximum in Tamil Nadu. The shortfall of health workers in PHCs and CHCs is also very much, female health workers (the 2nd highest) and male health workers (the third highest among the states taken for discussion). In the shortfall of female health assistants in PHCs also Tamil Nadu shows a backward position. Operation theatre facility is available only in 6% of PHCs functioning in Tamil Nadu, but Gujarat is having this facility in all its PHCs. On the basis of rural population served, rural area covered, number of villages covered and radial distance covered, Tamil Nadu is not a better placed state. The budget allocation in revenue budget is continuously falling and the fall is very much in Tamil Nadu in comparison with other states except Odisha. All these force the people of Tamil Nadu to make use of private hospitals instead of public healthcare sector (only about 40%).

Barriers to Institutional Delivery-A Study on Tribals of Narmada District

Background: Every minute of every day, somewhere in the world and most often in a developing country, a woman dies from complications related to pregnancy or childbirth.1 as the health of newborn is directly linked with the health and wellbeing of mother, so interventions have been planned to address the issues of maternal health. Through National Rural Health Mission extensive focus has been made on institutional delivery services in order to develop millennium development goals no 1, 4 and 5 2 .In the process of utilization of health care particularly with respect to institutional delivery there are many challenges, and that increases to many fold if it is related to addressing the challenges related to tribal areas. The study explores the barriers to institutional delivery at tribal areas. Methods: Random sampling technique was adopted for the selection of blocks of the district. Qualitative methodology was adopted for the collection of data. The tools used for data collection were In-depth interview, Observation and Case study. The target population for gathering information were pregnant women, Female health workers, Medical officers and staff Nurses of PHC. Results: The main barriers in terms of utilization of institutional delivery services were, Lack of awareness about institutional delivery and government health schemes, Social customs as barriers, poor economic condition of the family, Lack of communication network. Conclusion: The institutional delivery services in tribal areas are affected by various factors which if remain addressed will lead to increase in maternal deaths in the region. The barriers to institutional delivery at tribal areas can be addressed with effective planning.

“A study to assess correlates of low birth weight (LBW) in periurban area of Chandigarh, India”

INTRODUCTION: - Birth weight of the baby is an important indicator of reproductive health and general health status of population. LBW is considered the single most important predictor of infant mortality, especially of deaths within the first month of life. Since we don’t have any data regarding low birth weight and its associated factors in this area so the present study was conducted. MATERIALS AND METHODS: The study was conducted at RHTC under the Department of Community Medicine of Govt. Medical College, Chandigarh where female health workers from Department of Health of Chandigarh Administration are also posted. RESULTS: - Out of these the prevalence of low birth weight was 11.7 % for males and 19.5% for females. Total prevalence of LBW babies was found to be 15.5%.

CAUCASUS WAR AND REFORMS OF 60-70 - IES OF THE XIX CENTURY AS FACTORS OF INTEGRATION OF WOMEN IN THE PROFESSIONAL MEDICAL ACTIVITIES IN DAGESTAN (XIX - EARLY XX CENTURIES)

This article discusses issues related prerequisites involvement of women in the professional medical activities in Dagestan XIX - early XX centuries. It is emphasized that the entry of Dagestan of the Russian Empire, the ensuing Caucasian war had a positive impact on the edge of medicine in general, and creating conditions for the involvement of women in the medical profession. Analyzes the main institutional arrangements in the field of study on the involvement of women in the sphere of medicine, particularly in the context of their national area. Historical analysis of women's access to the sphere of medicine shows that in the study period, according to tradition, only the profession of traditional healers and midwives could be available to women. It is also noted that the integration of women in professional medicine factors become bourgeois reforms 60-70 - ies of the XIX century, secular education, population growth, industrial development in the cities.. The collected data show that the peoples of Dagestan, the proportion of women in medicine has not been high. Attention is drawn to the fact that in Dagestan there was virtually no qualified female health workers from representatives of local nationalities.

SUSTAINING MOTIVATION AMONG COMMUNITY HEALTH WORKERS IN AIDS CARE IN KWAZULU‐NATAL, SOUTH AFRICA: CHALLENGES AND PROSPECTS

A substantial part of community‐based AIDS care in South Africa is currently undertaken by poor, female volunteer community health workers (CHWs). Retention of volunteers over time is challenging, however. In this study, 12 female AIDS care volunteers in KwaZulu‐Natal, South Africa, were interviewed about their motivations for becoming volunteers, perceived challenges in care work, and reasons for sustained volunteering. All women reported altruism and empathy as their main motivation for volunteering. Motivations for sustained volunteering included supportive networks, hopes of future employment in the formal health care system, personal growth, and appreciation from patients and community members. Despite reporting several challenges, all women were motivated to continue volunteering. To encourage retention, policy makers should pay attention to personal and professional rewards gained from volunteering, create career paths and clarify CHWs' roles and rights in the health care sector, and provide various coordination and support measures, including remuneration and stigma reduction.

Determinants of Persistent Anemia in Poor, Urban Pregnant Women of Chandigarh City, North India: A Mixed Method Approach.

Maternal anemia continues to be a public health problem in India, despite existence of multipronged governmental programs to combat it. This study explores the determinants of persistent anemia in poor pregnant women in an urban population in Chandigarh, India. A mixed method approach was used to examine the causes of maternal anemia. Three focus group discussions with pregnant women from different socioeconomic groups and 2 with female health workers were conducted to explore their perceptions and beliefs about maternal anemia and iron folic acid (IFA) tablets in urban settings in 2009. This was followed by interviews of 120 pregnant women about their nutrition knowledge and practices. Food frequency questionnaires were used to estimate daily consumption of nutrients. Finally, a follow-up survey in health clinics explored issues of stock-outs of IFA. Sixty-five percent of respondents had hemoglobin less than 11g/dL and were anemic. Only 35% respondents obtained free IFA through public health programs. While 53% of respondents knew that they should eat green leafy vegetables, only 8% reported daily consumption of these vegetables. Focus group discussions highlighted issues around lack of food, especially for slum women, and low decision-making power in the household. Stock-outs of IFA in facilities often pushed women to purchase IFA from chemist shops. Clear gaps emerged in pregnant women's knowledge and practice regarding diet and IFA tablet use. Lack of control over decision-making due to their low status of women was also hindering IFA use and healthy eating.

How a Technical Agency Helped Scale Up a Community Health Worker Program: An Exploratory Study in Chhattisgarh State, India

—India's goal of universal health coverage underscores the need for scale in community action for health. Among the few successes in community programs is Chhattisgarh's Mitanin Program, designed and maintained at the scale of the entire state (covering almost 20 million). Evaluations of scaled-up interventions typically examine population health outcomes, placing less emphasis on how programs succeed or fail. To address this knowledge gap, we undertook a qualitative research study to explore the role of the State Health Resource Centre (SHRC), a state technical agency, in scaling up Chhattisgarh's Mitanin health worker program over a ten-year period commencing in 2002. We undertook observation, policy documentary review, in-depth interviews, and focus group discussions with policy/program developers, facilitators and trainers, community health workers, and representatives of civil society. Data analysis followed an inductive approach of qualitative data analysis and data were thematically organized in the form of folk theories including interlinked contexts, mechanisms, and outcomes reflecting the experience of the SHRC in scaling up community action for health in the state. The first folk theory links the enabling context of the formation of a new state with mechanisms of pluralistic and multistakeholder governance of the SHRC and avoidance of overt political patronage of the program, contributing to the sustainability of the program through multiple administrative and political transitions. The second folk theory elaborates how equity-focused mechanisms such as linking the program to locally important, intersectoral agendas for marginalized communities and attentiveness to career trajectories of female frontline workers created space for these workers to organize and demand livelihood rights against a broader context where the indigenous tribal minority and women are widely excluded from the social and political mainstream. These exploratory findings illustrate how the pluralistic governance structure of the SHRC, coupled with a set of unique contextual strategies, contributed to the longevity of the program and professional growth and opportunities for female community health workers, with lessons for other low- and middle-income country decision makers.

Repeated training of accredited social health activists (ASHAs) for improved detection of visceral leishmaniasis cases in Bihar, India

Accredited Social Health Activists (ASHAs) are incentive-based, female health workers responsible for a village of 1000 population and living in the same community and render valuable services towards maternal and child health care, polio elimination program and other health care-related activities including visceral leishmaniasis (VL). One of the major health concerns is that cases remain in the endemic villages for weeks without treatment causing increased likelihood to treatment failure and disease transmission in the community. To address this problem, we have begun a training program for ASHAs to enhance early detection of potential VL cases and referring them to their local Primary Health Centers (PHCs) for diagnosis and treatment. The result of this training showed increased referral rate to PHCs for diagnosis and treatment. Encouraged with the results from a single training session, we determined in the present study whether repeated training of ASHAs resulted in an a further increase in VL case referral to the local PHCs. After two training sessions, VL referrals by ASHAs increased to 46% as compared to 28% after a single training session in this cohort and a baseline of 7% before training. ASHA training is an effective way to conduct active case detection of VL cases and should be repeated once a year.

Outcome of RMNCH training of female health workers at regional health and family welfare training centre in northern part of India

Background: Reducing maternal and child mortality were among the most important goals of the National Rural Health Mission with aim to increase institutional deliveries. NRHM identified the role of RMNCH councilors for advocacy and communication and social mobilization of disadvantaged people. In Himachal Pradesh Female Health workers were trained as RMNCH councilors at district level. Objectives of the study were to assess the knowledge of female health workers regarding postpartum family planning, reproductive, maternal, newborn and child health before and after administering structured teaching programme, to update knowledge and quality counseling skills on postpartum family planning, reproductive, maternal, newborn and child health and to evaluate the effectiveness of structured teaching programme by comparing the pretest and posttest knowledge scores regarding postpartum family planning, reproductive, maternal, newborn and child health . Methods: Regional Health and Family Welfare Training Centre, Chheb, Kangra; imparted training to the female health workers of 6 districts. Five days Training was held in three batches of 20 participants each. Didactic lectures were delivered by experienced specialist of public health professionals, gynaecologist and paediatricians. Standardized training material developed by Government of India was used. Results: A total of 60 participants were enrolled but only 52 participated. The average age of the participants was 35 years ±5.7 years. The participants had an average 10 years of working experience. A majority 46% of these participants were working at Primary Health Centre. Knowledge mean score of various thematic areas of participants increased from mean score of 21.9 to 25.4. It was observed that after training post-test knowledge score showed significant improvement. Paired T test was found to be extremely significant (p<0.000) . Conclusions: Participants in a short course training focussing on RMNCH had significant improvements in scores on tests of knowledge gained. Widespread implementation of similar training under NRHM may bridge knowledge gaps for various health functionaries but still whether shorter knowledge gains are retained in the longer term remains unknown.

Reproductive, Maternal, Newborn, and Child Health in the Community: Task-sharing Between Male and Female Health Workers in an Indian Rural Context.

Background:Male community health workers (CHWs) have rarely been studied as an addition to the female community health workforce to improve access and care for reproductive, maternal, newborn, and child health (RMNCH).Objective:To examine how male health activists (MHAs) coordinated RMNCH responsibilities with existing female health workers in an Indian context.Materials and Methods:Interviews from male and female CHWs were coded around community-based engagement, outreach services, and links to facility-based care.Results:Community-based engagement: MHAs completed tasks both dependent and independent of their gender, such as informing couples on safe RMNCH care in the antenatal and postnatal periods. MHAs motivated males on appropriate family planning methods, demonstrating clear gendered responsibility. Outreach services: MHAs were most valuable traveling to remote areas to inform about and bring mothers and children to community health events, with this division of labor appreciated by female health workers. Link to facility-based services: MHAs were recognized as a welcome addition accompanying women to health facilities for delivery, particularly in nighttime.Conclusion:This study demonstrates the importance of gendered CHW roles and male-female task-sharing to improve access to community health events, outreach services, and facility-based RMNCH care.

Assessment of maternal and child health services during Mamta days in urban areas of Surat City

Background: Mamta Divas is a fixed day, fixed site, preventive, and promotive health-care service center for mother and child population. Growth health checkup, immunization, primary treatment, referral, and counseling services are provided by FHW (Female Health Worker), ANM (Auxiliary Nurse Midwife) and AWW (Anganwadi Worker). Objective: To study the reproductive and child health services during Mamta days among the beneficiaries of health-care facility centers. Materials and Methods: It was a cross-sectional study conducted in 20 urban health centers of Surat Corporation Area from July 2012 to June 2013 by using pretested, semi-structured questionnaire for the assessment of maternal and child health services during the Mamta days. Result: In all sites it was noted that vaccine vial monitor of vials was in stage I or II, freeze-sensitive vaccines were in liquid form, vaccines have readable label, all vaccines were within expiry date, and all providers knew which vaccine cannot be reused. Information about follow-up date was provided in 94.59% session sites, followed by family planning advice in 67.57%, and nutrition advice in 60.81%. Breast-feeding assessment and examination were not done by them. Abdominal palpation was not performed in 88.52% of session sites because of lack of privacy as separate rooms and curtains were unavailable. Conclusion: Maternal and child health services were not provided satisfactorily in many session sites, therefore, training and retraining of health workers is required for better outcome.

Assessment of availability and pattern of utilization of institutional obstetric care by Venn exercises in rural Mysore, India

Background: With improving indicators of maternal and child health (MCH) the increasing expenditure of the Government on health can be substantiated. But considering the growing number of hospitals in private sector, it is desirable to understand the preference of the rural population. Methodology: Four primary health centres (PHCs) were selected from the district by stratified random sampling based on their performance in MCH. Accredited social health activist (ASHA), female and male health workers of selected PHC were involved in Venn exercise to explore the availability and utilization pattern. Results: Villages nearer to district headquarter had plenty of options (hospitals) and institutions were fewer as they went away from headquarter. Maximum mothers used PHC for registration of pregnancy and basic antenatal care. Nearby community health centres (CHC), talluka and district hospitals were utilized by more than 90% mothers for intranatal care. Very few mothers preferred private hospitals for intranatal care because of high cost and unavailability of maternity benefits. In tribal PHC area, NGO hospital was preferred more than public sector due to preference of lady doctor. Cost of care was minimum with decreasing distance from district/talluka hospital. Private hospitals were charging two to three times the expenditure in public sector for the same service. Conclusion: Delivery facility was available within 10 to 15 Km distance of each village and government sector was the leading obstetric care provider in the study area.

Women's Group Intervention Is Tied to Lower Neonatal Mortality In Rural Communities in India

An intervention involving participatory women's groups facilitated by government-approved social workers was associated with reduced neonatal mortality in rural communities in eastern India, according to a cluster-randomized controlled trial conducted between 2009 and 2012. (1) Compared with births to women living in control communities, those to women living in intervention communities had 31% lower odds of resulting in death of the infant within the first 28 days of life (odds ratio, 0.7). In addition, the odds of certain home care practices--e.g., birth attendant's using a safe delivery kit and placing the infant against the mother's skin within one hour of birth--were greater for births occurring in intervention communities than for those in control communities (odds ratios, 1.4-5.1). For the study, researchers chose 30 clusters--geographic areas with a population of about 5,000 individuals each--from five rural districts of the Jharkhand and Odisha states of eastern India. Half the clusters were randomly selected to receive an intervention, which was implemented in September 2010 and consisted of a series of women's group meetings led by village-based accredited social health activists (ASHAs)--female community health workers trained under India's National Rural Health Mission. ASHAs purposively invited pregnant women and new mothers to participate; however, the meetings were open to all local women. During meetings, women discussed maternal and newborn health problems, strategized about how to solve them, implemented the strategies and assessed their progress. Control clusters did not receive the group meeting intervention; however, in all clusters, the researchers met with village health sanitation and nutrition staff, and with government officials and hospital management to address issues relevant to maternal and newborn health. Data were collected for a baseline period consisting of the year before the intervention was implemented and for a two-year evaluation period beginning three months after implementation. Monitoring teams attempted to ascertain all births and deaths to women of reproductive age living in study clusters through reports from local key informants and through birth records. Researchers interviewed mothers about six weeks after a delivery to document pregnancy- and birth-related events and practices, and conducted verbal autopsies for deaths among infants and mothers. One intervention cluster was lost to follow-up and was dropped from analyses. Descriptive analyses were used to compare baseline characteristics across groups, and logistic regression analyses were conducted to assess whether the intervention was associated with various outcomes, primarily neonatal mortality (i.e., death of an infant in the first 28 days of life), as well as home care and care-seeking practices. During the baseline period, 3,244 women (1,635 from intervention clusters and 1,609 controls) experienced 3,304 births. Overall, the mean age of mothers was 24.7 years; 65% could not read, and 58% had not attended school. The socioeconomic characteristics of women were the same across groups, except a greater proportion of women in the control group than of those in the intervention group had a secondary or higher education (33% vs. …

Addressing Behavioral Health Disparities for Somali Immigrants Through Group Cognitive Behavioral Therapy Led by Community Health Workers.

To test the feasibility and acceptability of implementing an evidence-based, peer-delivered mental health intervention for Somali women in Minnesota, and to assess the impact of the intervention on the mental health of those who received the training. In a feasibility study, 11 Somali female community health workers were trained to deliver an 8-session cognitive behavioral therapy intervention. Each of the trainers recruited 5 participants through community outreach, resulting in 55 participants in the intervention. Self-assessed measures of mood were collected from study participants throughout the intervention, and focus groups were conducted. The 55 Somali women who participated recorded significant improvements in mood, with self-reported decreases in anxiety and increases in happiness. Focus group data showed the intervention was well received, particularly because it was delivered by a fellow community member. Participants reported gaining skills in problem solving, stress reduction, and anger management. Participants also felt that the intervention helped to address some of the stigma around mental health in their community. Delivery of cognitive behavioral therapy by a community health workers offered an acceptable way to build positive mental health in the Somali community.

Do Physical Proximity and Availability of Adequate Infrastructure at Public Health Facility Increase Institutional Delivery? A Three Level Hierarchical Model Approach.

This study aims to examine the inter-district and inter-village variation of utilization of health services for institutional births in EAG states in presence of rural health program and availability of infrastructures. District Level Household Survey-III (2007–08) data on delivery care and facility information was used for the purpose. Bivariate results examined the utilization pattern by states in presence of correlates of women related while a three-level hierarchical multilevel model illustrates the effect of accessibility, availability of health facility and community health program variables on the utilization of health services for institutional births. The study found a satisfactory improvement in state Rajasthan, Madhya Pradesh and Orissa, importantly, in Bihar and Uttaranchal. The study showed that increasing distance from health facility discouraged institutional births and there was a rapid decline of more than 50% for institutional delivery as the distance to public health facility exceeded 10 km. Additionally, skilled female health worker (ANM) and observed improved public health facility led to significantly increase the probability of utilization as compared to non-skilled ANM and not-improved health centers. Adequacy of essential equipment/laboratory services required for maternal care significantly encouraged deliveries at public health facility. District/village variables neighborhood poverty was negatively related to institutional delivery while higher education levels in the village and women’s residing in more urbanized districts increased the utilization. “Inter-district” variation was 14 percent whereas “between-villages” variation for the utilization was 11 percent variation once controlled for all the three-level variables in the model. This study suggests that the mere availability of health facilities is necessary but not sufficient condition to promote utilization until the quality of service is inadequate and inaccessible considering the inter-districts variation for the program implementation.