From the Ordinary to Corruption in Higher Education

[We’re pleased to welcome author Mildred A. Schwartz of the University of Illinois at Chicago. Schwartz recently published an article in the Journal of Management Inquiry entitled “From the Ordinary to Corruption in Higher Education.” From Schwartz:]

When I moved to New Jersey after many years of teaching in Chicago, my interest as a political and organizational sociologist was piqued by theJMI_72ppiRGB_powerpoint.jpg kind of corruption I learned of.  Not fully satisfied with existing theories and explanations, I began thinking of how to approach corruption as a sociological phenomenon.  Then, when I read local press coverage about misconduct at the University of Medicine and Dentistry of New Jersey (UMDNJ), I felt that I had found the ideal case
for exploring how corruption could arise even within such an unexpected setting–a university dedicated to the health care professions.

Of all the findings that came from my research, at least two were surprising.  One was the prevalence of many of the illegal or unethical behaviors found at UMDNJ in other U.S. universities that had medical schools.  The second was the ability of UMDNJ and other universities, despite misconduct, to still fulfill their duties to train health care professionals, advance scientific research, and treat the sick.

I would like to think that my findings will inspire efforts at controlling organizational corruption, particularly as it is manifested in higher education.  At least three guidelines emerged from the larger research, discussed in my book, Trouble in the University:  How the Education of Health Care Professionals became Corrupted (Brill, 2014).  One is the importance of enough transparency to allow organizational participants to understand how decisions are made.  Second is the need for accepted avenues through which to express complaints without fear of reprisal.   Third, and this is especially relevant to state-supported universities although it is not confined to them, is the need for firm boundaries between politics and education.

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Book Review: Selling Our Souls: The Commodification of Hospital Care in the United States

bookjacketSelling Our Souls: The Commodification of Hospital Care in the United States. By Adam D. Reich Princeton, NJ: Princeton University Press, 2014. 248 pp. ISBN 978-0-6911-60405, $39.50

Nick Krachler recently published a book review in ILR ReviewAn excerpt from the review:

Reich’s main focus is on the institutional legacies that shape how the people working in his cases reconcile the contradictions between their non-economic values and market pressures. The former public hospital’s contradiction is between the scarcity of resources and the practice of providing extensive uncompensated care to underinsured and uninsured patients. The people in this hospital view care as a social right, and Reich interprets their disregard for efficiency and profitability as rebuffing market pressures. In the Catholic hospital, the contradiction is between the values of sacrifice and dignity, with which many in the hospital identify, and management’s Current Issue Covermarketing of these values to attract high-paying patients, the treatment of uninsured patients with little dignity, and the lowest wages for nurses and ancillary workers among the three cases studied. Reich interprets this case as moralizing market pressures. In the integrated health management organization, customized care according to each patient’s special needs contradicts the organization’s prevailing operating principle of standardizing and rationing care by scaling up efficient practices. Reich interprets this case as taming market pressures through the use of bureaucracy and big data. The author lays out these three types of moral–market relationships by examining the conception of care, the structure of physicians’ work, and the power and division of labor between physicians, nurses, and ancillary workers including the role of labor relations in each of the cases. Another interesting argument in the book is that these three different moral–market relationships correspond to three different historical periods. I find Reich’s well-grounded discussion and critique of the three models highly persuasive.

If you’d like to read the full review from ILR Review, you can click here to access the book review for the next two weeks. Interested in staying up to date with all the latest content published by ILR ReviewClick here to sign up for e-alerts!

Overcoming Obstacles to Establish the Largest Voluntary Employees’ Beneficiary Association

16687016354_ca450d18ec_z[We’re pleased to welcome Frank Giancola, HR researcher and retired practitioner for companies like Ford Motor Company, Eastern Michigan University, and the US Air Force. Frank recently published an article in Compensation Benefits Review entitled “The Turbulent History of the Nation’s Largest Voluntary Employees’ Beneficiary Association.”]

I decided to write an article about the U.S. auto workers’ healthcare VEBA for several reasons. First, I thought that the VEBA concept was not well-known in the benefits profession and that additional coverage was warranted. Second, the history of the auto workers’ VEBA tracks the timeline of the recent decline, bankruptcies, and Current Issue Coverrevival of the auto companies, one of the nation’s most important industries that directly and indirectly is responsible for millions of American jobs. Legacy health care costs were an important factor driving the bankruptcies. Third, I had the good fortune to work for one of the involved companies, Ford Motor Company, as a benefits professional, so I had first-hand knowledge of the issues and how the companies work with the hourly employees’ union, the United Auto Workers, to establish innovative employee benefit programs.

The union proposed the VEBA to the companies, as a means to protect the health care benefits of its retired members. Because of its commitment to its members, and the companies’ responsibility to its retirees and need to mitigate huge legacy costs, the parties were able to overcome monumental challenges that threatened the existence of the VEBA. The success of the VEBA demonstrates the ability of the collective bargaining process to deal effectively with a major issue in our country.

I was pleasantly surprised to see that the VEBA was able to provide medical benefits to over 500,000 retirees without encountering significant start-up difficulties, and that supplemental plan funding was obtained from reductions in the pay of active employees.

It is my hope that readers will find this history to be interesting and informative, so that when faced with the rising costs of providing health care benefits to retirees, they will have another option to consider to meet the challenge.

The abstract for the paper:

The Detroit automakers’ Retiree Medical Benefits Trust is the nation’s largest Voluntary Employees’ Beneficiary Association (VEBA). It is an independent trust with assets of $60 billion that is responsible for providing medical, prescription drug, dental and vision benefits to 720,000 hourly retirees, surviving spouses and dependents of General Motors, Ford and Fiat Chrysler. It was established in 2007 through the joint efforts of the Big Three Detroit automakers and the United Automobile Workers Union primarily to protect the health care benefits of hourly retirees and to provide the companies with financial relief from the burdens of legacy costs that eventually contributed to their bankruptcies. Although it is now viewed as a success, there were times in its history when its inception and future were seriously in doubt. A review of its history will inform HR professionals of the problems and solutions they may encounter in establishing a VEBA.

You can read “The Turbulent History of the Nation’s Largest Voluntary Employees’ Beneficiary Association” from Compensation Benefits Review free for the next two weeks by clicking here. Want to stay current on all of the latest research from Compensation Benefits Review? Click here to sign up for e-alerts!

*Image attributed to Pictures of Money (CC)

ILR Review Special Issue: Work and Employment Relations in Health Care

8639003804_2bd2b5f140_zThe August special issue of ILR Review is now available and open to access for the next 30 days! Included in the special issue on Work and Employment Relations in Health Care are papers that discuss the relationship between nurse unions and patient outcomes, the effect of electronic health record adoption on physician productivity, and the impact nurse staffing strategies have on patient satisfaction. In the introductory editorial essay, Ariel C. Avgar, Adrienne E. Eaton, Rebecca Kolins Givan, and Adam Seth Litwin outline the problems inherent in US health care, most notably the fact that despite outspending other countries on health care costs per capita, the US demonstrates above-average rates of medical errors and below-average life expectancies. As the health care system moves toward reform, the authors argue for careful consideration of how workplace dynamics impact the outcomes for everyone involved in health care. The editorial thus highlights the importance of research on work and employment relations in the health care industry:

This special issue of the ILR Review is designed to showcase the central role that work organization and employment relations play in shaping important outcomes such as the quality of care and organizational performance. Each of the articles included in this special issue makes an important contribution to our understanding of the large and rapidly changing health care sector. Specifically, these articles provide novel Current Issue Coverempirical evidence about the relationship between organizations, institutions, and work practices and a wide array of central outcomes across different levels of analysis. This breadth is especially important because the health care literature has largely neglected employment-related factors in explaining organizational and worker outcomes in this industry. Individually, these articles shed new light on the role that health information technologies play in affecting patient care and productivity (see Hitt and Tambe; Meyerhoefer et al.); the relationship between work practices and organizational reliability (Vogus and Iacobucci); staffing practices, processes, and outcomes (Kramer and Son; Hockenberry and Becker; Kossek et al.); health care unions’ effects on the quality of patient care (Arindrajit, Kaplan, and Thompson); and the relationship between the quality of jobs and the quality of care (Burns, Hyde, and Killet). Below, we position the articles in this special issue against the backdrop of the pressures and challenges facing the industry and the organizations operating within it. We highlight the implications that organizational responses to industry pressures have had for organizations, the patients they care for, and the employees who deliver this care.

You can read the special issue of ILR Review free for the next 30 days by clicking here. Want to stay current on all of the latest research published by ILR Review? Click here to sign up for e-alerts!

*Nurse image attributed to COD Newsroom (CC)

Transformative Service Research: A Multidisciplinary Perspective on Service and Well-being

Republished with permission. The original post was published on the Center for Services Leadership blog.

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Interview with Laurel Anderson and Amy Ostrom, Editors of the Special Issue of Journal of Service Research, Transformative Service Research: A Multidisciplinary Perspective on Service and Well-being

02JSR13_Covers.inddIn August of this year Journal Service Research published a highly anticipated special issue on Transformative Service Research, a Multidisciplinary Perspective on Service and Well-being. The entire issue will be available free of charge till November 2015 and can be downloaded from the journal’s website. We’re very excited to feature the special issue in this podcast and on our blog, where we’ll be sharing posts by the authors of the three finalists for Best Paper Award.

Darima Fotheringham: Today I’m talking to the guest co-editors of the special issue, Professors Laurie Anderson and Amy Ostrom from Arizona State University. Professor Anderson, Professor Ostrom, thank you for talking to us today.

Laurel Anderson, Amy Ostrom: Thank you, it’s good to be here.

Darima Fotheringham: As you mentioned in the editorial, Transformative Service Research is a fairly new research area that’s been gaining momentum. For those who are not familiar with the term, can you start by defining Transformative Service Research, or TSR, and explain why it is receiving so much attention and interest in the research community today?

Laurel Anderson: We define TSR, Transformative Service Research, as focusing on services and well-being, and in particular, as research that has to do with creating uplifting changes. And one of the key things about the definition is that we look not at just individuals but also at collectives like family or communities, ecosystems, society. These aspects are some of the things we found in the papers that came in that were different from a lot of the research in service.

Darima Fotheringham: And going back to the second part of the question, why do you think there is so much interest from the research community in this particular topic?

Amy Ostrom: There’s always been some interest in studying well-being issues in general, but I think we’ve seen an increase interest in the last five or six years. Some of it, likely due to discussions about what should research priorities be in the service field. And as part of some research priority setting efforts, this idea of studying service and well-being really came to the forefront. We’ve seen really a community of service researchers form, who really want to better understand this connection between service and well-being. And as that community has grown, we’ve seen more and more special sessions at conferences, research projects at a significant nature getting started, and it’s really been very exciting to see.

Darima Fotheringham: The TSR special issue includes ten very diverse articles. They’re from around the world and cover different industries, discuss different cultures. In the editorial you identified three big themes. Can you talk a bit about those themes and share a couple of examples that would illustrate some of the new interesting concepts that the readers can take away?

Laurel Anderson: We were just really excited to see the diversity of the papers that came in. That’s part of what we wanted to accomplish also, to indicate how broad this field is both in method, and cultures, and content, and theories conceptually. So the three themes that we found arising from the data were ones that we thought were innovative, and provocative, and had a lot of heft to them. For example one is the de-struction of value. We always talk about the co-creation of it, creation of value, but haven’t really given time to look as much at some of the destruction of value. That is a really interesting topic. And as the papers in this area point out, sometimes it is unintentional, sometimes it’s unknowingly destructive, and sometimes it’s intended.

So for example, the article, the lead paper, which was the award winning article by Per Skålén, Kotaiba Abdul Aal, and Bo Edvardsson, looks at what they call strategic action fields. It looks at the incumbents in that field and it looks at challengers in this service area. This is amazing data because it looks at Syria and how the regime, as incumbents, took away services to many of the population. Then how that population reacted and created new services under the constraints that they had. So the destruction was an important part. That one is a very vivid, kind of unusual example. But sometimes it is also more everyday kinds of things, like chronic illness, where people really don’t want to be in a service. They’d rather not be participating in the service. There are a lot of negative aspects to the chronic part. We want to make sure that we’re looking at some of the negative aspects of services so that we can deal with those, which I think is really important.

Amy Ostrom:  One of the other themes that we highlighted involved co-production or co-creation, which are really looking at the roles and activities that consumers play as part of service. And while questions around co-production and co-creation have been the focus of a lot of research, not much of that work has really looked at well-being. We definitely had some articles where that was the focus, trying to understand how the activities and roles that consumers took as part of the service, how that ultimately impacted their well-being.

So for example, one of the papers authored by Jillian C. Sweeney, Tracey S. Danaher, and Janet R. McColl-Kennedy looked at what they call ‘effort in value co-creation activities.’ So really looking at how much effort consumers, in this case patients who are dealing with chronic illness, what kind of activities are they taking on? The whole idea behind their work was this notion that some of these activities or the roles are actually more effortful than others, and that patients or these individuals dealing with chronic illness will take on the easy activities first and then progress to the more effortful activities. So they were able to really look at the nature of these activities, things that they’re doing for themselves, things that they’re doing related to other people. What’s really fascinating is that they were able to look at the effort that these individuals were expending in terms of these various activities and relate that to things like quality of life. It really highlights, spotlights, how consumers and roles they’re taking on, the activities they are engaging in part of a service, really can impact their well-being.

Laurel Anderson:  We’ve looked at providers before to some extent, and the production, the co-creation, but not emphasized consumers and their well-being as much.

Amy Ostrom: It’s kind of exciting that we’re actually starting to see some research where we’re looking at more innovative measures. Oftentimes some of the research involves more perceptual measures. We are seeing that researchers are starting to use actual behavior measures or maybe more objective measures to really understand the nature of well-being, changes that are happening. So for example Martin Mende and Jenny van Doorn look at co-production in the context of consumers participating in debt management programs, and they look at, over time, the impact of consumers who are in those programs—their co-production and its impact on an objective measure, a change in credit scores, as well as things like increased stress perceptions. So we’re really seeing some interesting relationships between, again, how people are co-producing or their role within the organization and their level of well-being.

Darima Fotheringham: In your editorial you also identified specific areas within TSR that required further research. Can you talk about these areas and share examples of research questions that you personally find especially important or intriguing?

Amy Ostrom: One of the areas that we continue to talk about, and I know that others are really devoted to studying it as well, is what’s called Base of the Pyramid, or studying individuals, really billions of people in the world who are living under a few dollars a day. And a lot of the research that’s done in service work and just academic work in general in any area doesn’t tend to pay attention to individuals living in those particular types of circumstances. So there’s much to learn about consumers living in those situations, and a lot to learn from them, and the creativity that’s demonstrated in individuals that are living in what we refer to as the Base of the Pyramid.

Laurel Anderson: Another area, that we believe is very important, has to do with stress, being really cognizant of stress and the impact of stress on consumers. One of the other methods or approaches that we also feel is very important is an interdisciplinary approach where we’re bringing in knowledge from maybe the biological sciences, neurology, some of the other fields like nursing, or medicine, or law. One of the areas where there’s just fascinating research on stress has to do with the impact of stress on the body of a person. We’ve known for quite a while that stress impacts the well-being of a person, but there’s some very interesting research now that looks at the impact of stress on the body and then on how it’s passed on to the next generation—I think it just emphasizes the importance of well-being for the consumers that are participating in services and incorporating some of the interdisciplinary research that’s out there on the impacts of stress. So it’s a very fruitful and important area to pursue.

Amy Ostrom: The other area that we talk quite a bit about that’s not too surprising is the impact that technology is having in services that are based on technology and the relationship with well-being. And in this day where so much of our behavior can be tracked and monitored, issues around what that means for privacy and service settings and potential harm that can come from that. The fact that service providers now can know information about us and be continually tracking our behavior, the potential that raises for all sorts of potentially harmful well-being aspects, but at the same time a lot of benefits, when you think about monitoring and health related aspects, that can be really empowering for consumers to be able to live their lives knowing that the service provider, a doctor, is able to know at any time if there are any issue. But it does change the nature of the dynamic.

Laurel Anderson: It does, and it raises something we found throughout, which is trade-offs. There are trade-offs in some benefits to well-being and the negative aspects of, for example, technology and monitoring. Those are really important aspects to talk about and to research too. In addition, as far as trade-offs are concerned, sometimes there are trade-offs between the well-being of one group and the well-being of another group. And who decides then which is going to be prioritized in their well-being? So there are some really complex questions around well-being and trade-offs that we saw coming out of some of the research.

Amy Ostrom: I think it highlights the need to look broader than just the dyad, the trade-offs at community levels and service system levels. It is the key to why we have to look at the broader picture than often times we tend to do. It’s hard research to do, and very difficult, but very important given the nature of these kinds of interaction trade-offs that are effecting so many of us on a daily level.

Darima Fotheringham: You conclude the editorial by recommending specific actions that can help TSR make a real impact on society. The call to action is mostly directed to the research community, but as you mentioned we can all benefit from data in the field. Is there anything as consumers, as customers, or as individuals can do to support this research?

Laurel Anderson: I think that one of the areas that is challenging with regards to consumers themselves and well-being is a trend that we’re seeing that’s called responsibilization. What that means is that services, and governments, and policy are putting more responsibility for wellbeing onto the consumers. And it demands a high level of literacy on the part of the consumer, and so for example health—consumers have to know so much more now about the health, and their bodies, and the medical field because the responsibility is being put more on them than in the past. So as far as consumers are concerned that’s one of the issues as far as trade-offs. Yes, more of the choices on the consumers parts, but also more of the responsibility and decision making, maybe without some of the expertise to be able to do that. So things like literacy, having the time to do that, the resources and capacity I think are real challenges for consumers to manage. And if you have to do that in all the different areas of service, from health to legal to financial, it’s a lot to expect of consumers.

Darima Fotheringham: It’s very taxing.

Laurel Anderson: Right.

Amy Ostrom: When I think about what consumers can do, from the research perspective, what I hope is that the consumer would be willing to participate in some of the research that we and academic research, really globally, are interested in doing. The type of work that we do and the questions that we’re trying to answer really require partnerships with consumers to understand how the services they’re using day and day out are in fact impacting their well-being. Whether it’s healthcare, financial services, it requires that kind of participation. So I hope going forward that people will be willing to participate in research and share their thoughts, as I hope that organizations, individuals who work with consumers in different service settings are willing to collaborate with researchers. A lot of the research questions really require partnering with organizations, and one of the real goals of Transformative Service Research is to have impact—to actually improve the lives of consumers, and the only way that happens is really through organizations, companies who are basically effecting consumers day and day out—Learning what can positively impact well-being and doing more of those things, and learning what reduces well-being and stopping doing those things. And it’s those kind of partnerships that are actually going to lead to the impact that we’d want to see in the community and individuals.

Laurel Anderson: And I think it’s so important to listen to the customers in whatever service they’re in—the voice of the consumer. And it’s interesting because when we don’t, now consumers are creating their own research. There are communities of consumers that are doing research on topics that they think are important and that aren’t being followed up on by researchers. For example, a site called Patients Like Me where they’re monitoring themselves, and doing research, and finding significant results because the questions weren’t being addressed. So I think it’s really important to not just look at things from our research point of view, but to be listening to the consumer and to be incorporating those aspects that are frontline to them into our research too.

Darima Fotheringham: Great, thank you so much. We were talking to the editors of a JSR special issue on Transformative Service Research, a Multidisciplinary Perspective on Service and Well-being. You can find the entire issue, including the editorial we talked about on the website. Professor Anderson, Professor Ostrom, thank you for talking to me today.

Laurel Anderson, Amy Ostrom: Thank you, Darima


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Laurel Anderson is Associate Professor of Marketing at Arizona State University. She has degrees in both marketing and community health. She is deeply involved with development of Transformative Service Research (TSR).  In particular, she focuses on creativity and innovation, going between cultural worlds, health well-being, challenges and strengths related to poverty, culture and immigration and services as social structures. Previously, she was Director of the Institute for International Management at Arizona State University. Prior to academics, she developed community health programs focused on children and families, including a crisis intervention center for children.

Ostrom-Amy (Small) 2015

Amy L. Ostrom is the PetSmart Chair in Service Leadership Professor in Services Leadership, Chair and Professor of Marketing at the W. P. Carey School of Business at Arizona State University. She received her Ph.D. from Northwestern University. Her research focuses on issues related to services marketing including customers’ evaluation and adoption of services, customers’ roles in creating service outcomes, and transformative service. Ostrom, who was selected as the 2004 Arizona Professor of the Year and the 2007 ASU Parents Association Professor of the Year, has supervised numerous undergraduate Honors theses. She has shared the service blueprinting technique with small start-ups to Fortune 500 companies to help improve their service processes and develop new service offerings.

Using Social Marketing in China to Reduce the Spread of Cysticerosis

tap-1564536[We’re pleased to welcome Mary Dickey of the University of Oklahoma Health Sciences Center. Dr. Dickey recently published “Program Evaluation of a Sanitation Marketing Campaign Among the Bai in China: A Strategy for Cysticercosis Reduction” with Robert John, Helene Carabin, and Xiao-Nong Zhou in Social Marketing Quarterly.]

I saw first-hand the problems with sanitation through my involvement in community development work in rural China. Although emphasis is often placed on new technology in sanitation, I observed that promoting behavioral change was the real challenge. Poor sanitation causes many diseases and one that was of special interest to me was cysticercosis. Cysticercosis is a leading cause of epilepsy among the Bai minority group in Yunnan, China.

I found that many among the Bai already understood the relationship between sanitation and disease but F1.mediumthat understanding did not seem to affect toilet construction and use. Since health education alone did not seem to be an answer, we researched the use of sanitation marketing among the Bai. This research reveals how formative data was collected to help researchers understand not only the sanitation situation but also the thoughts and opinions of the Bai related to toilet use. This data was used to design a social marketing campaign to promote toilets with the specific goal of reducing cysticercosis. The results of the campaign in two intervention villages are compared with the results of a more conventional government promotion in two comparison villages. This is the first report of the use of social marketing of toilets in China. Although more research is needed, this program evaluation indicates that sanitation marketing in rural China is an appropriate approach to increase sanitation coverage.

You can read “Program Evaluation of a Sanitation Marketing Campaign Among the Bai in China: A Strategy for Cysticercosis Reduction” from Social Marketing Quarterly for free by clicking here. Don’t forget to sign up for e-alerts and get all the latest news and research from Social Marketing Quarterly sent directly to your inbox!

Are Young Mothers in India Deprived of Maternal Health Care Services?

life-10-weeks-1439841Young women are at a higher risk of poor birth outcomes. Studies have found increased risk of preterm delivery, intrauterine growth retardation and low birth weight among adolescents (Amini et al. 1996; Fraser et al. 1995; Satin et al. 1994). Additionally, the risk of maternal death is higher among teenagers compared to older women (Gupta et al. 2010; Midhet et al. 1998; Neto et al. 2009). According to Reynolds et al. (2006), in South Asia there is a lack of decision-making power due to the effects of gender inequality, which ultimately results in a lower use of health services. They also found a strong correlation between maternal age and the use of maternal and child health care services in Bangladesh, India and Indonesia.

A recent study published in Journal of Health Management entitled “Are Young Mothers in India Deprived of Maternal Health Care Services? A Comparative Study of Urban and Rural Areas” explores the vulnerability of young mothers to poor pregnancy outcomes and their utilization of health care services. The study results clearly establishes that efforts should be made to strengthen the reproductive health programs for adolescent women. Young women may not have enough knowledge on pregnancy, reproductive health issues and adoption of health services for these issues. Mass campaigns to educate women on the symptoms of pregnancy and its complications would help women to use maternal health care services effectively.

The abstract:

This article attempts to study the effect of age of women at birth on the use of maternal health care F1.mediumservices separately for urban and rural areas using data from the National Family Health Survey (NFHS)-3, 2005–2006, India. The indicators of use of maternal health care services used in this study are use of antenatal care services recommended by the World Health Organization (WHO) (includes three or more antenatal check-ups during the first trimester, two or more tetanus toxoid (TT) injections and taking 100 iron and folic acid tablets during pregnancy), place of delivery, assistance at delivery and use of postnatal care services. At first, the percentage of births that utilized various maternal health care services are discussed separately for urban and rural areas, followed by difference in utilization of maternal health care services between adolescent and adult mothers. Finally, logistic and multinomial regressions are used to examine the influence of age of women at birth on the use of maternal health care services for controlling for other factors. Multivariate results revealed that women who gave birth during adolescence are less likely to use antenatal, natal and postnatal care services in both urban and rural areas. Therefore, efforts should be made to educate parents and other family members on the consequences of early marriage and early pregnancy and also the importance of delaying marriage.

Click here to read “Are Young Mothers in India Deprived of Maternal Health Care Services? A Comparative Study of Urban and Rural Areas” for free from Journal of Health Management!

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