A household study of the pattern of utilization of mother and child health services in rural Greece and variation by socioeconomic status.

Abstract

Summary A household study of all families with children under 6 years in three villages in rural north‐west Greece was conducted in August‐September 1981. Ninety‐four mothers were interviewed about each of their children to find out who they had consulted seeking advice and care during pregnancy, for delivery, in the post‐natal period, for child immunization, and in cases of mild or severe child illness. All 142 children were examined physically and developmentally. Information was also collected on the socioeconomic status of the family. Particular causes for concern were the findings that 30% of the mothers said they had experienced at least one induced abortion; 5% had delivered without the help of any trained birth attendant; most of those who delivered in the district town (usually the better off) had received no postnatal care; 37% of children had not seen a doctor in their first year of life either for sickness or for a developmental assessment. Only 41% of children were fully immunized for their age, and 23% of those who should have started their immunizations had not begun. Most of the 30 children who had been severely or chronically ill had bypassed the local doctor and sought services in the district town. There was clear variation in the pattern of use of health services and socioeconomic status as shown by the availability of household facilities including water and electricity. The poorer mothers (30% of the sample) were more likely than the better‐off mothers to have delivered at home. Many had had the help of the local midwife, but all those who had no help from a trained attendant came from the poorer families. Post‐natal care was provided to most (79%) of these families, by the midwife. The poorer the family the more likely that a sick child would be treated with a home remedy. Children from poor families were likely never to have seen a doctor and if a child did go, it was likely to be older at the time of its first visit. Very few poor families had ever consulted a specialist. Mothers in a better‐off situation were more likely to have delivered in the district town at a private clinic with a specialist obstetrician. They were unlikely to have received any post‐natal care. Their children were likely to be younger when first taken to the doctor for a routine developmental check‐up, usually in the first year of life. Home remedies were less likely to be used for child illnesses. It is suggested that the experienced rural community midwife is providing an excellent service to mothers from all social strata ante‐natally; in delivery and post‐natal care for poorer mothers, and in informal child care for everyone. She is well respected in the community and knows and is well known to all the children. It is suggested that the trend found for better‐off mothers to go to the town for some private health services may undermine the crucial role the midwife has at the village level in rural Greece in pro‐tecting the health of the poor and less educated mother.