Bargaining Power within Couples and Health Care Provider Choice in Tanzania

Abstract

AbstractThis paper examines the pattern of health care provider choice in relation to couples’ bargaining power, in a country where most communities are basically patriarchal, with limited legal protection for women. We use the Tanzanian Demographic and Health Survey (2010) and a nested multinomial logit model to distinguish between public and private facility choice. Evidence suggests that cooperation in decision‐making, female discretion over household resources and low domestic violence increase the probability of childbirth in a health facility. We find that cooperation in household decision‐making and low incidence of domestic violence significantly increase the probability of private facility use. The effects of these social and economic dimensions of the distribution of power between spouses on health care use remain significant after controlling for household resource endowment. A policy option that encourages cooperation between couples, reduces domestic violence and/or ensures female empowerment is more likely to enhance the use of reproductive health services.