ABSTRACT Title of Dissertation: DOMESTIC VIOLENCE EXPOSURE, MATERNAL EDUCATION, AND MATERNAL AUTONOMY AS PREDICTORS OF INDIAN WOMEN’S USE OF MATERNAL HEALTH SERVICES AND INFANT LOW BIRTH WEIGHT

Title of Dissertation: DOMESTIC VIOLENCE EXPOSURE, MATERNAL EDUCATION, AND MATERNAL AUTONOMY AS PREDICTORS OF INDIAN WOMEN’S USE OF MATERNAL HEALTH SERVICES AND INFANT LOW BIRTH WEIGHT Mili Duggal, Doctor of Philosophy, 2015 Dissertation directed by: Professor Sally A. Koblinsky Department of Family Science India contributes disproportionately to the world’s maternal mortality ratio and rate of infant low birth weight. Securing adequate antenatal care and delivery in a hospital or health facility are key strategies aimed at improving India’s maternal and infant health outcomes. This study utilized the National Family Health Survey-3 (NFHS3) to investigate predictors of Indian women’s use of maternal health care services and delivery of a low birth weight infant. The ecological model of health was used to examine how the individual level factor of maternal education and the relationship level factors of women’s domestic violence exposure and maternal autonomy were related to maternal and infant outcomes. Specifically, the study examined the role of physical violence, psychological violence, sexual violence, maternal education, and maternal autonomy in predicting women’s receipt of adequate antenatal care, institutional delivery, and likelihood of delivering a low birth weight child. The study utilized NFHS-3 data from 2005-06 with a sample of 4,983 Indian women who gave birth in the previous year. This survey was the first to include a module addressing three different types of domestic violence exposure within the marital relationship. Findings revealed that 19% of women reported experiencing physical violence, 10% reported psychological violence, and 8% reported sexual violence in the previous year. Multivariate logistic regression analyses examined the association between the targeted maternal variables and women’s use of maternity health services and infant low birth weight. Domestic violence emerged as a risk factor, with physical violence predicting less adequate antenatal care and higher likelihood of low infant birth weight. Psychological violence predicted lower likelihood of adequate antenatal care and institutional delivery, and sexual violence was associated with a lower likelihood of institutional delivery. In contrast, both maternal education and maternal autonomy emerged as protective factors. Maternal education was predictive of adequate antenatal care, institutional delivery, and lower likelihood of infant low birth weight, while maternal autonomy predicted institutional delivery and lower likelihood of delivering a low birth weight infant. Implications of the findings for policy makers, public health practitioners, and educators seeking to improve maternal and infant outcomes in India are discussed. DOMESTIC VIOLENCE EXPOSURE, MATERNAL EDUCATION, AND MATERNAL AUTONOMY AS PREDICTORS OF INDIAN WOMEN’S USE OF MATERNAL HEALTH SERVICES AND INFANT LOW BIRTH WEIGHT