Utilizing maternal healthcare services: are female-headed households faring poorly?

Antenatal care India Maternal healthcare Postnatal care Sex of household head Skilled birth assistance

Journal

BMC pregnancy and childbirth

ISSN: 1471-2393

Titre abrégé: BMC Pregnancy Childbirth

Pays: England

ID NLM: 100967799

Informations de publication

Date de publication:
22 Apr 2024

Historique:

received: 19 05 2023

accepted: 25 03 2024

medline: 23 4 2024

pubmed: 23 4 2024

entrez: 22 4 2024

Statut: epublish

Résumé

Utilization of maternal healthcare services has a direct bearing on maternal mortality but is contingent on a wide range of socioeconomic factors, including the sex of the household head. This paper studies the role of the sex of the household head in the utilization of maternal healthcare services in India using data from the National Family Health Survey-V (2019-2021). The outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest. 24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves. The results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses. Not Applicable. D10, I12, J16.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

The outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest.

RESULTS RESULTS

24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves.

CONCLUSION CONCLUSIONS

The results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses.

TRIAL REGISTRATION BACKGROUND

Not Applicable.

JEL CLASSIFICATION BACKGROUND

D10, I12, J16.

Identifiants

DOI: 10.1186/s12884-024-06445-8 PMID: 38649989

pubmed: 38649989

doi: 10.1186/s12884-024-06445-8

pii: 10.1186/s12884-024-06445-8

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

299

Informations de copyright

Références

World Health Organization. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. World Health Organization; 2019.

Hamal M, Dieleman M, De Brouwere V, de Cock Buning T. Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India. Public Health Rev. 2020;41(1):1–24.

doi: 10.1186/s40985-020-00125-6

Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189–200.

doi: 10.1016/S0140-6736(06)69380-X pubmed: 17011946

Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J, et al. Maternal health in poor countries: the broader context and a call for action. Lancet. 2006;368(9546):1535–41.

doi: 10.1016/S0140-6736(06)69384-7 pubmed: 17071287

Rosenfield A, Charo RA, Chavkin W. Moving forward on reproductive health. N Engl J Med. 2008;359(18):1869–71.

doi: 10.1056/NEJMp0806807 pubmed: 18971489

Jat TR, Ng N, San Sebastian M. Factors affecting the use of maternal health services in Madhya Pradesh state of India: a multilevel analysis. Int J Equity Health. 2011;10:59.

doi: 10.1186/1475-9276-10-59 pubmed: 22142036 pmcid: 3283453

Rizkianti A, Afifah T, Saptarini I, Rakhmadi MF. Women’s decision-making autonomy in the household and the use of maternal health services: an Indonesian case study. Midwifery. 2020;90:102816.

doi: 10.1016/j.midw.2020.102816 pubmed: 32823256

Streatfield K, Singarimbun M, Diamond I. Maternal education and child immunization. Demography. 1990;27(3):447–55.

doi: 10.2307/2061378 pubmed: 2397822

Yaya S, Uthman OA, Amouzou A, Ekholuenetale M, Bishwajit G. Inequalities in maternal health care utilization in Benin: a population based cross-sectional study. BMC Pregnancy Childbirth. 2018;18(1):194.

doi: 10.1186/s12884-018-1846-6 pubmed: 29855277 pmcid: 5984297

Okedo-Alex IN, Akamike IC, Ezeanosike OB, Uneke CJ. Determinants of antenatal care utilisation in sub-saharan Africa: a systematic review. BMJ Open. 2019;9(10):e031890.

doi: 10.1136/bmjopen-2019-031890 pubmed: 31594900 pmcid: 6797296

Ghosh A, Ghosh R. Maternal health care in India: a reflection of 10 years of National Health Mission on the Indian maternal health scenario. Sex Reprod Healthc. 2020;25:100530.

doi: 10.1016/j.srhc.2020.100530 pubmed: 32434138

Mehari K, Wencheko E. Factors affecting maternal health care services utilization in rural Ethiopia: a study based on the 2011 EDHS data. Ethiop J Health Dev. 2013;27(1):16–24.

Bain LE, Aboagye RG, Dowou RK, Kongnyuy EJ, Memiah P, Amu H. Prevalence and determinants of maternal healthcare utilisation among young women in sub-saharan Africa: cross-sectional analyses of demographic and health survey data. BMC Public Health. 2022;22(1):647.

doi: 10.1186/s12889-022-13037-8 pubmed: 35379198 pmcid: 8981812

Sanogo NA, Yaya S. Wealth status, Health Insurance, and Maternal Health Care Utilization in Africa: evidence from Gabon. Biomed Res Int. 2020;2020:4036830.

doi: 10.1155/2020/4036830 pubmed: 32461984 pmcid: 7212326

Leone T, James KS, Padmadas SS. The burden of maternal health care expenditure in India: multilevel analysis of national data. Matern Child Health J. 2013;17(9):1622–30.

doi: 10.1007/s10995-012-1174-9 pubmed: 23114861

Anchang-Kimbi JK, Achidi EA, Apinjoh TO, Mugri RN, Chi HF, Tata RB, et al. Antenatal care visit attendance, intermittent preventive treatment during pregnancy (IPTp) and malaria parasitaemia at delivery. Malar J. 2014;13:162.

doi: 10.1186/1475-2875-13-162 pubmed: 24779545 pmcid: 4019363

Raghupathy S. Education and the use of maternal health care in Thailand. Soc Sci Med. 1996;43(4):459–71.

doi: 10.1016/0277-9536(95)00411-4 pubmed: 8844947

Mumtaz S, Bahk J, Khang YH. Current status and determinants of maternal healthcare utilization in Afghanistan: analysis from Afghanistan demographic and Health Survey 2015. PLoS ONE. 2019;14(6):e0217827.

doi: 10.1371/journal.pone.0217827 pubmed: 31185028 pmcid: 6559709

Pebley AR, Goldman N, Rodríguez G. Prenatal and delivery care and childhood immunization in Guatemala: do family and community matter. Demography. 1996;33(2):231–47.

doi: 10.2307/2061874 pubmed: 8827167

Zhang R, Li S, Li C, Zhao D, Guo L, Qu P, et al. Socio-economic inequalities and determinants of maternal health services in Shaanxi Province, Western China. PLoS ONE. 2018;13(9):e0202129.

doi: 10.1371/journal.pone.0202129 pubmed: 30183720 pmcid: 6124721

Buvinic M, Gupta GR. Female-headed households and female-maintained families: are they worth targeting to reduce poverty in developing countries? Econ Dev Cult Change. 1997;45(2):259–80.

doi: 10.1086/452273

Dreze J, Srinivasan PV. Widowhood and poverty in rural India: some inferences from household survey data. J Dev Econ. 1997;54(2):217–34.

doi: 10.1016/S0304-3878(97)00041-2

Meenakshi JV, Ray R. Impact of household size and family composition on poverty in rural India. J Policy Model. 2002;24(6):539–59.

doi: 10.1016/S0161-8938(02)00129-1

Karlsen S, Say L, Souza JP, Hogue CJ, Calles DL, Gülmezoglu AM, et al. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on maternal and Perinatal Health. BMC Public Health. 2011;11:606.

doi: 10.1186/1471-2458-11-606 pubmed: 21801399 pmcid: 3162526

Hailu M, Gebremariam A, Alemseged F, Deribe K. Birth preparedness and complication readiness among pregnant women in Southern Ethiopia. PLoS ONE. 2011;6(6):e21432.

doi: 10.1371/journal.pone.0021432 pubmed: 21731747 pmcid: 3120869

Moinuddin M, Christou A, Hoque DME, Tahsina T, Salam SS, Billah SM, et al. Birth preparedness and complication readiness (BPCR) among pregnant women in hard-to-reach areas in Bangladesh. PLoS ONE. 2017;12(12):e0189365.

doi: 10.1371/journal.pone.0189365 pubmed: 29228050 pmcid: 5724858

Adde KS, Dickson KS, Amu H. Prevalence and determinants of the place of delivery among reproductive age women in sub-saharan Africa. PLoS ONE. 2020;15(12):e0244875.

doi: 10.1371/journal.pone.0244875 pubmed: 33382825 pmcid: 7774912

Amu H, Seidu AA, Agbaglo E, Dowou RK, Ameyaw EK, Ahinkorah BO, et al. Mixed effects analysis of factors associated with health insurance coverage among women in sub-saharan Africa. PLoS ONE. 2021;16(3):e0248411.

doi: 10.1371/journal.pone.0248411 pubmed: 33739985 pmcid: 7978354

Pandey S, Karki S. Socio-economic and Demographic Determinants of Antenatal Care Services Utilization in Central Nepal. Int J MCH AIDS. 2014;2(2):212–9.

pubmed: 27621975 pmcid: 4948147

Yadav AK, Jena PK. Maternal health outcomes of socially marginalized groups in India. Int J Health Care Qual Assur. 2020;33(2):172–88.

doi: 10.1108/IJHCQA-08-2018-0212

Mohammed BH, Johnston JM, Vackova D, Hassen SM, Yi H. The role of male partner in utilization of maternal health care services in Ethiopia: a community-based couple study. BMC Pregnancy Childbirth. 2019;19(1):28.

doi: 10.1186/s12884-019-2176-z pubmed: 30642280 pmcid: 6332901

Sharma A, Khapre M, Meshram R, Gupta A. Determinants of utilization of antenatal care services among recently delivered women residing in urban poor areas of Rishikesh, Uttarakhand, India-a cross-sectional study. J Rural Med. 2023;18(2):87–95.

doi: 10.2185/jrm.2022-030 pubmed: 37032991 pmcid: 10079463

Titaley CR, Dibley MJ, Roberts CL. Factors associated with underutilization of antenatal care services in Indonesia: results of Indonesia demographic and Health Survey 2002/2003 and 2007. BMC Public Health. 2010;10:485.

doi: 10.1186/1471-2458-10-485 pubmed: 20712866 pmcid: 2933719

Azhar K, Dharmayanti I, Tjandrarini DH, Hidayangsih PS. The influence of pregnancy classes on the use of maternal health services in Indonesia. BMC Public Health. 2020;20(1):372.

doi: 10.1186/s12889-020-08492-0 pubmed: 32197649 pmcid: 7082955

Wang W, Temsah G, Mallick L. The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia, and Rwanda. Health Policy Plan. 2017;32(3):366–75.

pubmed: 28365754