scholarly journals Empirical Analysis of Socio-Economic Determinants of Maternal Health Services Utilisation in Burundi

2021 ◽  
Author(s):  
Desire Habonimana ◽  
Neha Batura
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health Professional ◽  
Maternal Health Services ◽  
Long Distance ◽  
Economic Determinants ◽  
Pregnancy And Childbirth ◽  
Point Of Use ◽  
Education Levels ◽  
Trained Health Professional

Abstract BackgroundTimely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distance to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite prenatal, childbirth and postanal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four antenatal care (ANC) visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.MethodsWe use data from the 2017 Burundian Demographic and Health Survey (DHS) collected from 8,941 women who reported a live birth in the five years preceding the survey. We use multiple regression analysis to explore the factors that determine the likelihood of seeking ANC services from a trained health professional, the number of ANC visits made and the choice of assisted childbirth. ResultsOccupation, marital status and wealth increase the likelihood of seeking ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than others. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are assisted during childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth. ConclusionsIn Burundi, utilisation of maternal health services is low. There is inequality in services utilisation among women based on wealth, parity, religion, and occupation. ANC is an important determinant of subsequent delivery care. There is a gap between married and unmarried women. This has a strong health policy implication to improve access to maternal health services for unmarried women.

scholarly journals Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi

2020 ◽  
Author(s):  
Desire Habonimana ◽  
Neha Batura
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health Professional ◽  
Maternal Health Services ◽  
Long Distance ◽  
Economic Determinants ◽  
Pregnancy And Childbirth ◽  
Point Of Use ◽  
Education Levels ◽  
Trained Health Professional

Abstract Background Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distance to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite prenatal, childbirth and postanal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four antenatal care (ANC) visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.Methods We use data from the 2017 Burundian Demographic and Health Survey (DHS) collected from 8,941 women who reported a live birth in the five years preceding the survey. We use multiple regression analysis to explore the factors that determine the likelihood of seeking ANC services from a trained health professional, the number of ANC visits made and the choice of assisted childbirth.Results Occupation, marital status and wealth increase the likelihood of seeking ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than others. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are assisted during childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth.Conclusions In Burundi, utilisation of maternal health services is low. There is inequality in services utilisation among women based on wealth, parity, religion, and occupation. ANC is an important determinant of subsequent delivery care. There is a gap between married and unmarried women. This has a strong health policy implication to improve access to maternal health services for unmarried women.

scholarly journals Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Desire Habonimana ◽  
Neha Batura
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health Professional ◽  
Multivariate Regression Analysis ◽  
Maternal Health Services ◽  
Wealth Status ◽  
Economic Determinants ◽  
Pregnancy And Childbirth ◽  
The Government ◽  
Trained Health Professional

Abstract Background Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distances to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite antenatal care (ANC), delivery and postnatal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four ANC visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi. Methods We use data from the 2016–2017 Burundi Demographic and Health Survey (DHS) collected from 8941 women who reported a live birth in the five years that preceded the survey. We use multivariate regression analysis to explore which individual-, household-, and community-level factors determine the likelihood that women will seek ANC services from a trained health professional, the number of ANC visits they make, and the choice of assisted childbirth. Results Occupation, marital status, and wealth increase the likelihood that women will seek ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than non-educated women and women not in union. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are to have assisted childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth. Conclusions In Burundi, utilisation of maternal health services is low and is mainly driven by legal union and wealth status. To improve equitable access to maternal health services for vulnerable population groups such as those with lower wealth status and unmarried women, the government should consider certain demand stimulating policy packages targeted at these groups.

scholarly journals Conceptualizing "access" of maternal health services in lower-middle-income countries

2020 ◽  
Vol 11 (1) ◽  
pp. 108-111
Author(s):  
Bismah Jameel ◽  
Aeda Bhagaloo ◽  
Khadija Rashid ◽  
Umair Majid
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Health Services ◽  
Political Factors ◽  
Middle Income ◽  
Pregnancy And Childbirth ◽  
Middle Income Countries ◽  
Health System Improvement ◽  
Barriers To Access ◽  
System Improvement

A considerable number of women die each year worldwide due to preventable causes during pregnancy and childbirth. The high mortality of women who die from pregnancy-related issues can be attributed to inadequate access of high-quality maternal health services. However, access is a nebulous concept with a compendium of conceptualizations and definitions. In this paper, we discuss the various conceptualizations of access to maternal health services in lower middle-income countries, and compare how issues related to access differ between high- and lower middle-income countries. This discussion informs two priorities that we suggest for researchers conducting health system improvement work in lower middle-income countries: 1) develop a robust understanding of the barriers to access that continue to persist due to cultural, socioeconomic, and political factors, and 2) formulate frameworks and theories specific to lower middle-income countries to guide research.

scholarly journals Psychosocial Influences on Pregnancy and Childbirth Behaviors in Northwestern Nigeria: A Cross-Sectional Analysis

2020 ◽  
Author(s):  
Emily White Johansson ◽  
Udochisom Anaba ◽  
Dele Abegunde ◽  
Mathew Okoh ◽  
Shittu Abdu-Aguye ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Behavior Change ◽  
Self Efficacy ◽  
Maternal Health Services ◽  
Facility Delivery ◽  
Cross Sectional ◽  
Pregnancy And Childbirth ◽  
Psychosocial Influences ◽  
And Behavior

Abstract BackgroundAntenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in northwestern Nigeria. To increase service use, social and behavior change (SBC) programs target psychosocial influences across cognitive, emotional and social domains including knowledge, beliefs, self-efficacy, and social norms. Yet there remains limited research that measures and quantitatively examines the role of psychosocial influences on pregnancy and childbirth behaviors in Nigeria or elsewhere. MethodsA cross-sectional population-based survey of randomly sampled women with a child under two years was conducted in Kebbi, Sokoto and Zamfara states of northwestern Nigeria in September 2019. Women were asked about maternal health behaviors during their last pregnancy. New psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behavior Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and sociodemographic variables.ResultsAmong 3,039 women, 23.6% (95% CI: 18.0%-30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8%-20.1%) gave birth in a facility. Among women who did not attend ANC4+ times or have a facility-based delivery during their last pregnancies, the most commonly cited reasons were lack of perceived need (42% and 67%, respectively) and spousal opposition (25% and 27%, respectively). Women who knew any ANC benefit or the recommended number of ANC visits were 3.2- and 2.1-times more likely to attend ANC4+ times. Women who held positive views about health facilities for childbirth had 1.2- and 2.6-times higher likelihood of attending ANC4+ times and facility delivery, while women who believed ANC was only for sickness or pregnancy complications had 17% lower likelihood of attending ANC4+ times. Self-efficacy and supportive spousal influence were also significantly associated with both outcomes.ConclusionsTo improve pregnancy and childbirth practices in northwestern Nigeria, programs should address a range of psychosocial factors – across cognitive, emotional and social domains – that were significantly associated with pregnancy and childbirth behaviors: raising knowledge and dispelling myths, building women’s confidence to access services, engaging spousal support in decision-making, and improving perceived (and actual) maternal health services quality.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

Maternal health services in China’s western rural areas: uptake and correlates

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Chengfang Liu ◽  
Linxiu Zhang ◽  
Yaojiang Shi ◽  
Huan ZHOU ◽  
Alexis Medina ◽  
...  
Keyword(s):  
Public Health ◽  
Maternal Health ◽  
Health Services ◽  
Health Systems ◽  
Uptake Rate ◽  
Rural Areas ◽  
Design Methodology ◽  
Maternal Health Services ◽  
Western China ◽  
Public Health Systems

Purpose Many public health systems have struggled with the dual questions of (1) why the uptake rate of maternal health services is low among some subpopulations; and (2) how to raise it. The objective of this study is to assess the uptake rate of a new set of maternal health services in poor rural areas of China. Design/methodology/approach The analysis is based on the survey responses of women’s representatives and village cadres from almost 1000 villages in June 2012 as part of a wide-scale public health survey in Sichuan, Gansu and Yunnan provinces in the western part of China. Findings We find that the uptake rate of maternal health services (including in-hospital delivery, antenatal care visits and post-partum care visits) in poor rural areas of western China are far below average in China, and that the rates vary across provinces and ethnic groups. Our analyses demonstrate that distance, income, ethnicity and availability appear to be systematically correlated with low uptake rates of all maternal health services. Demand-side factors seem to be by far the most important sources of the differences between subpopulations. We also find that there is potential for creating a Conditional Cash Transfer program to improve the usage of maternal health services. Originality/value We believe that our results will contribute positively to the exploration of answers to the dual questions that many public health systems have struggled with (1) why the uptake rate of maternal health services is low among some subpopulations; and (2) how to raise it.

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