Economic status, education and empowerment: implications for maternal health service utilization in developing countries.

Saifuddin Ahmed,Duff G Gillespie,Andreea A Creanga,Amy O Tsui,Beverley J Shea

doi:10.1371/journal.pone.0011190

Abstract

BackgroundRelative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries.Methods/Principal FindingsThe analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth.Conclusions/SignificanceEfforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1), universal primary education (MDG 2), and women's empowerment (MDG 3).

Highlights

The disparity in maternal mortality between poor and rich regions of the world is striking
Our analyses examine the relationships between the 3Es and maternal health care utilization, use of modern contraception, attendance of four or more antenatal care visits as per the WHO recommendation [29], and skilled birth attendance
Results for the 31 countries closely match those for the 21 African countries suggesting the importance of the 3Es for women everywhere

Summary

Introduction

The disparity in maternal mortality between poor and rich regions of the world is striking. Conditions amenable to intervention by skilled health providers are involved in about 80% of maternal deaths, and to date, the core strategy for driving down maternal mortality has been to increase access to emergency care around the time of delivery [2]. While skilled birth attendance and emergency obstetric care are essential to securing significant reductions in maternal mortality, health service expansion by itself is unlikely to be enough. Relative to the attention given to improving the quality of and access to maternal health services, the influence of women’s socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women’s economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries

Objectives

Methods

Results

Conclusion