Abstract
BackgroundThe republic of Benin ranks in the bottom third of countries recently assessed for ANC coverage and its Ministry of Family and National Solidarity (2009) reported close to 70% of Beninese women suffered abuse at least once in their lifetime. Utilization of antenatal care (ANC) services is key to positive health outcomes for both mother and infant. This study examined the impact of intimate partner violence (IPV) on the utilization of ANC services in Benin using both the basic 4 visit model (ANC-4) and the updated WHO recommended 8-visit model (ANC-8).MethodsData used for this study were collected from the nationally representative 2017–2018 Benin Demographic Health Survey (BDHS) on ever-partnered women aged 15–49 who had completed both reproductive maternal health and domestic violence modules of the survey. Descriptive statistics and multivariate logistic regression analysis were performed to determine significant factors associated with ANC utilization in Benin.ResultsOver 40% of the women (n = 3084) reported experience of IPV in their lifetime. Findings revealed that women who ever experienced IPV (OR 0.753, 95% CI: 0.628–0.901; p = 0.002) had 25% less odds of accessing the basic four ANC visits. IPV was not found to be a factor in accessing at least eight ANC visits. With increasing number of children, there was less likelihood of accessing at least four and at least eight visits. Being in the richest quintile (OR 5.490, 95% CI 3.907–7.714; p < 0.000 for ANC-4; OR, 5.781, 95% CI: 3.208–10.41; p < 0.000), making decisions on household and health care (OR 1.279, 95% CI: 1.042–1.569 for ANC-4; OR, 1.724; 95% CI: 1.170–2.540; p = 0.006 for ANC-8), and getting paid cash for work increased the chances of utilizing ANC-four (OR 1.451, 95% CI: 1.122–1.876; 0.005) but not for ANC-eight. Belonging to the Muslim faith decreased the odds of ANC utilization compared to all other religions.ConclusionThis work revealed key areas for maternal health policy makers and service providers in Benin to appropriately plan effective policies (i.e., alleviate poverty; equitable health services access; cultural sensitivity) and necessary interventions (i.e. ANC education, IPV prevention, paid employment, alcohol cessation) to increase utilization of ANC.
Highlights
The republic of Benin ranks in the bottom third of countries recently assessed for Antenatal care (ANC) coverage and its Ministry of Family and National Solidarity (2009) reported close to 70% of Beninese women suffered abuse at least once in their lifetime
A significantly lower proportion of the women who experienced violence (8.68%) accessed ANC-8 compared to women who had not experienced violence (11.26%)
These findings suggest that women who never experienced intimate partner violence (IPV) had made more decisions regarding healthcare, household purchases or spending and visiting family relatives
Summary
The republic of Benin ranks in the bottom third of countries recently assessed for ANC coverage and its Ministry of Family and National Solidarity (2009) reported close to 70% of Beninese women suffered abuse at least once in their lifetime. Utilization of antenatal care (ANC) services is key to positive health outcomes for both mother and infant. The WHO has been working to improve quality of care and increase ANC coverage in low- and middle-income countries (LMICs) for the past two decades [1]. Research on ANC underutilization continues to emerge in low- and middle-income countries (LMICs) indicating continued negative outcomes for mothers and newborns [4, 5]. Factors affecting utilization of ANC among pregnant women have been identified; namely, maternal age, number of living children, education, place of residence, employment and source of income, decision making authority (autonomy), socio-demographic and economic characteristics of partner or husband, religion and ethnicity [6]. One emerging area of interest is the intersection between ANC utilization and intimate partner violence (IPV) where both the lives of the mother and child are at risk of direct physical harm, and the psychological and emotional consequences of the perpetrated violence
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