Abstract
BackgroundUnderstanding how socioeconomic factors influence maternal health services utilization is crucial to reducing preventable maternal deaths in the DRC. Maternal education is considered an important associate of maternal health service utilization. This study aims to investigate the association between maternal education and the utilization of maternal health services, as well as present geographical and socio-economic disparities in the utilization.MethodsThe MICS survey was employed as the data source, which is a nationally representative survey conducted from 2017 to 2018 in the DRC. The exposure for this study was the maternal education level, which was categorized into three groups: (1) below primary and none, (2) primary and (3) secondary and above. Prenatal care indicators included: if the mother ever received prenatal care, if the mother had antenatal checks no less than four times, and if a skilled attendant was present at birth. Postnatal care indicators included: if the mother received postnatal care and if the baby was checked after birth. Emergency obstetric interventions were indicted by cesarean sections. Descriptive analyses and logistic regressions were used as analytical methods.ResultsOf all 8,560 participants included, 21.88 % had below primary school or no education, 39.81 % had primary school education, and 38.31 % had secondary education or above. The majority of participants were from rural areas, except for Kinshasa. Overall, a better education was associated with higher utilization of antenatal care. A dose-response effect was also observed. Compared to women with below primary or no education, women with secondary and above education were more likely to receive cesarean sections. Wealth status, as well as rural and urban division, modified the associations.ConclusionsMothers’ education level is an important associate for utilizing appropriate maternal healthcare, with wealth and region as modifying factors. Educational levels should be considered when designing public health interventions and women’s empowerment programs in the DRC. For example, relevant programs need to stratify the interventions according to educational attainment.
Highlights
Understanding how socioeconomic factors influence maternal health services utilization is crucial to reducing preventable maternal deaths in the Democratic Republic of the Congo (DRC)
The Demographic and Health Surveys in the DRC indicated that maternal health service utilization, including antenatal care, postnatal care, and having skilled attendants at birth, was relatively poor in the country and disparities were prevalent across geographical locations and socioeconomic status [5, 7]
Using a large population-based database provided by UNICEF, the present study aims to investigate the association between maternal education and maternal health services utilization, including prenatal care, provision of antenatal checks at least four times before birth, postnatal care, and cesarean section in the DRC, with considerations of rural-urban and economic disparity
Summary
In sub-Saharan Africa, significant progress has been made in recent decades, young pregnant women are still facing enormous challenges in accessing and utilizing adequate maternal health services. This includes prenatal care, postnatal care, and emergency obstetric interventions [2, 3]. The Demographic and Health Surveys in the DRC indicated that maternal health service utilization, including antenatal care, postnatal care, and having skilled attendants at birth, was relatively poor in the country and disparities were prevalent across geographical locations and socioeconomic status [5, 7]
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