Paper short abstract:

The paper conceptualizes mobility within the CA framework, emphasizing its crucial role in expanding individuals' opportunities to attain desired health outcomes. It examines how variations in capability to mobility are influenced by factors such as geographic location, socio-economic status, cultural norms, and road and transport which affect women’s access to healthcare services using NFHS 5.

Paper long abstract:

Mobility capability is not only intrinsically important but instrumentally catalytic to what Sen calls an individual’s ‘doings and beings. The restrictions on the mobility of women reduce their capability to mobility to the lowest levels. Empirically, in India and many other countries restrictions on mobility have resulted in higher drop-out rates for girls, lower access to health, and lower participation of women in the labor market and public life; meaning mobility capability adversely affects many other capabilities (Tripathi & Mishra 2016, HDCA 2017, 2019). Our earlier work (unpublished, HDCA2019) has shown the role of the mobility capability – (instrumental role) in gaining an ‘identity’, ‘exposure’, ‘information’, and ‘advice’ to the women participating in SHGs. Building on our previous work the present paper attempts to understand the interaction between capability to mobility and health capability as embedded in healthcare-seeking behavior, which in turn is affected by the availability of health services, information, and affordability. To understand it we have conceptualized healthcare utilization as a manifestation of agency constrained by contextual factors—like informational barriers, financial constraints, and cultural norms—highlighting the complex decision-making processes underlying women’s utilization of health services.

The paper is divided into two parts. The first part of the paper explores the conceptualization of mobility within the CA framework, emphasizing its crucial role in expanding individuals' opportunities to attain desired health outcomes. Further, the paper examines the link between capability to mobility and access to healthcare services. It examines how variations in capability to mobility are influenced by factors such as geographic location, socio-economic status, cultural norms, and road and transport which affect women’s access to healthcare services.

In the second part of the paper utilizing the data from the National Family Health Survey NFHS- 5 (2019-2020), we measure capability to mobility based on freedom of mobility constrained by private transport owned by the household and violence against women in public. Here, freedom of mobility is measured on a scale of three, 1-free to move, 2- needs male permission, 3- needs male escort to go outside the village, health centre, and parent’s home. Health capability is based on actual visits to health centers for oneself or children and health outcomes of women as nested in awareness, travel time, transportation, and affordability of healthcare facilities.

Since female’s freedom of mobility is nested within the availability of road and transport and violence in public, it can’t be captured from simple regression analysis. Therefore we used the structural equation model (SEM) and path analysis to construct freedom of mobility as a latent variable and in the second stage analyzed its effect on women’s access to health services and their health capability as a composite indicator of utilization of health services and health outcome. As discussed above woman’s actual utilization of healthcare services is considered as a woman’s extension of agency contingent on her capability to mobility, health infrastructure, and affordability. Drawing upon Sen's CA, this paper examines how variations in capability to mobility affect individuals' capability to health.

The result of the study suggests that in rural areas with limited transportation infrastructure, women face significant barriers in reaching healthcare facilities, further suppressed by the restriction on mobility, and have the lowest visits to the health center. Moreover, socio-economic disparities, such as income inequality and educational attainment, are crucial factors for the mobility constraints and further impede the access to healthcare among women. The result of the study suggests that the greater the restriction on women’s mobility the lower their visits to the health centers and their awareness about diseases.

Keywords: Capability to mobility, Capability to health