Abstract
Development literature has argued that empowering women can effectively increase the utilisation of maternal health care. This study examines this hypothesis in the context of Nepal where only 28% of women delivered in facilities. The two-level random intercept logit models were fitted for data from the Nepal Demographic and Health Surveys 2011. Women‟s empowerment was quantified with a single index constructed from many variables. These variables captured different aspects of women‟s lives and decision-making in their households, and were combined using the principal component analysis method. The results confirmed a positive relationship between women‟s as an inevitable product of the economic development process.
Highlights
Despite substantial achievements in reducing child mortality over the past few decades, infant and neonatal mortality rates remain high in Nepal in comparison with other developing countries such as Vietnam, Indonesia and Philippines (PRB 2012)
1 y ij 0 if y βWE WEij δ' X ij εij ξ j ~ N 0, ψ ; εij ~ logistic where yi*j is the continuous latent response that links to the observed response yij via the threshold condition yi*j 0 ; the conditional expectation of yi*j is linked to a linear predictor via a logit function; the deterministic component includes coefficients WE and ', representing conditional or primary sampling unit (PSU)-specific effects of women‟s empowerment WEij and all the covariates affecting the decision on facility based delivery (FBD) X ij, the random effect ξ j, varying over PSU, follows a normal distribution with zero means and covariance matrix, ij is the residual at the individual level
The intra-cluster correlation is substantial and significant (0.32, 95% CI -0.04 - 0.67), suggesting that 31.6 per cent of the total variance in FBD utilisation could be explained at the cluster level
Summary
Despite substantial achievements in reducing child mortality over the past few decades, infant and neonatal mortality rates remain high in Nepal in comparison with other developing countries such as Vietnam, Indonesia and Philippines (PRB 2012). Home delivery is a common practice even in urban areas (Wagle et al, 2004; Sreeramareddy et al, 2006), while in rural areas 75% of deliveries took place at home (Government of Nepal 2011) It has been argued by O‟Donnell (2007) that a lack of facilities and trained medical workers is the main reason for low FBD utilisation; but while efforts to extend health services to women can lead to increased utilisation, there exists a gap between potential and actual utilisation of reproductive health care in Nepal. It provides a brief literature review on empirical studies that tested the relationship between empowerment and MCH utilisation.
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