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Background  More needs to be known about the role intra-familial power dynamics play in women’s reproductive health outcomes, particularly in societies like Northern India characterized by patriarchy and extended families. The key research question we explore is: how important are living arrangements (e.g., presence of the mother-in-law, presence of an elder sister-in-law, and living in the husband’s natal home) on contraceptive use behaviors and decision to deliver at an institution?    Methods  Representative data collected in 2010 from six cities in Uttar Pradesh are used to examine the above research question. This study uses multivariable logistic regression methods to examine the association between women’s household type (husband’s natal home vs. not husband’s natal home) and household composition (lives with mother-in-law; and lives with elder sister-in-law) and modern family planning use and institutional delivery.    Results  More than sixty percent of women in the sample live in their husband’s natal home, one-third live with their mother-in-law, and only three percent live with an elder sister-in-law. Findings demonstrate that women who live either with the mother-in-law or in the husband’s natal home are more likely to use modern family planning than those women living neither with the mother-in-law nor in the husband’s natal home. In addition, living with an elder sister-in-law is associated with less family planning use. For institutional delivery, women who live with the mother-in-law have higher institutional delivery than those not living with the mother-in-law. Multivariable analyses demonstrate that, controlling for other factors associated with modern family planning use, women living with neither the mother-in-law nor in the husband’s natal home are the least likely to use modern family planning. Similar findings are found for institutional delivery such that those women living with neither the mother-in-law nor in the husband’s natal home are the least likely to have an institutional delivery, controlling for demographic factors associated with institutional delivery.    Conclusions  Where women live and who they live with matters. Future reproductive health programs for urban India should consider these context specific factors in programs seeking to improve women’s reproductive health outcomes.

Descriptive study of the role of household type and household composition on women’s reproductive health outcomes in urban Uttar Pradesh, India