Abstract
BackgroundTimely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distances to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite antenatal care (ANC), delivery and postnatal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four ANC visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.MethodsWe use data from the 2016–2017 Burundi Demographic and Health Survey (DHS) collected from 8941 women who reported a live birth in the five years that preceded the survey. We use multivariate regression analysis to explore which individual-, household-, and community-level factors determine the likelihood that women will seek ANC services from a trained health professional, the number of ANC visits they make, and the choice of assisted childbirth.ResultsOccupation, marital status, and wealth increase the likelihood that women will seek ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than non-educated women and women not in union. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are to have assisted childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth.ConclusionsIn Burundi, utilisation of maternal health services is low and is mainly driven by legal union and wealth status. To improve equitable access to maternal health services for vulnerable population groups such as those with lower wealth status and unmarried women, the government should consider certain demand stimulating policy packages targeted at these groups.
Highlights
And appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes
Utilisation of antenatal care (ANC) services provided by a trained health professional A woman’s occupation and household wealth have significant positive impact on the likelihood of utilising ANC services from a trained health professional (Table 4). Those belonging to the third income quintile are more than three times more likely (OR = 3.407) to utilise ANC services from a trained provider
Women living in Kirundo or Mwaro province are two times less likely to utilise ANC services from a trained health professional
Summary
And appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. In low- and middle-income countries (LMICs), women often have poor health outcomes during pregnancy, childbirth, and the postpartum period [1]. These outcomes include severe bleeding, infections, high blood pressure, delivery complications, unsafe abortion, and Habonimana and Batura BMC Pregnancy Childbirth (2021) 21:684 the aggravation of pre-existing health conditions [2, 3]. The risk of a woman in a LMIC dying from a maternal-related cause during her lifetime is about 33 times higher compared to her counterpart in a highincome country [5] Such a risk remains high in resource-constrained settings such as Burundi [6]. Despite having made progress in maternal health indicators during the past three decades, Burundi has one of the highest maternal mortality ratios in the world: 712 maternal deaths per 100,000 live births which is the eighth highest in the world [2]
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