Abstract
BackgroundAchieving maternal health outcomes in the SDGs requires the implementation of more targeted policies and strategies. While the MDGs may have deepened our understanding in this regard, we know little about the trends in maternal health services utilisation among primigravidas, and how age and geographical regions could have influenced these trends. In this study, we examined utilisation of antenatal and skilled delivery services among primigravidas in Uganda, a country with one of the highest maternal mortality ratios, and where early childbearing and its attendant challenges are common.MethodsGuided by Andersen’s Behavioural Model, we fitted multivariate regression models to a pooled dataset of the 2006, 2011 and 2016 Ugandan Demographic and Health Survey (n = 3477) to understand the dynamics in Antenatal Care (ANC) and Skilled Birth Attendance (SBAs) utilisation among primigravidas. Post-estimation margins were employed to further highlight the effect of age and geographical regions.ResultsThe analyses show an improvement in access to maternal health services among primigravidas from 2006 to 2016. Compared to 2006, primigravidas in 2016 were 48%, 24% and 2.98 times more likely to have early ANC, four or more ANC visits, and SBAs, respectively. Altogether, a primigravida in 2016 relative to 2006 was 42% more likely to meet all three maternal health service indicators. Post-estimation margins analyses on age and geographical disparities revealed that younger primigravidas have lower probability, while primigravidas in Eastern Region, one of the most deprived in the country, have the lowest probability of accessing maternal health services. Also, the study found education, wealth, women’s household decision-making power, place of residence as important determinants of ANC visits and SBAs.ConclusionsBased on our findings, it is important to address the vulnerabilities of primigravidas, particularly younger individuals, in accessing early ANC. Uganda should scale-up decentralisation and integration of maternal health delivery in local communities as a strategy of addressing lingering geographical disparities, and ultimately improve maternal health outcomes in the SDGs period.
Highlights
Achieving maternal health outcomes in the Sustainable Development Goals (SDGs) requires the implementation of more targeted policies and strategies
Global Maternal Mortality Ratio (MMR) declined to 216 deaths per 100,000 live births, representing a 37% drop since year 2000, while global under-5 mortality fell to 43 deaths per 1000 live births, a decline of 44% over the same period
We study the utilisation of maternal health services among first time pregnant women with the aim of deepening our understanding of and contributing to the conversation around improving maternal and child health in the SDGs period
Summary
Achieving maternal health outcomes in the SDGs requires the implementation of more targeted policies and strategies. Global MMR declined to 216 deaths per 100,000 live births, representing a 37% drop since year 2000, while global under-5 mortality fell to 43 deaths per 1000 live births, a decline of 44% over the same period Despite this progress, it has been noted that global MMR should decline by about 7.5% annually, more than twice the annual rate of reduction in the MDG period, if the SDG target should be achieved come 2030 [2]. It has been noted that global MMR should decline by about 7.5% annually, more than twice the annual rate of reduction in the MDG period, if the SDG target should be achieved come 2030 [2] This requires expansion of access to quality maternal health services and identifying vulnerable groups of women for policy targeting. We study the utilisation of maternal health services among first time pregnant women (primigravidas) with the aim of deepening our understanding of and contributing to the conversation around improving maternal and child health in the SDGs period
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