Abstract
It is evident that maternal and under-five child deaths have gradually reduced in Sub-Saharan Africa (SSA) in the last three decades. In a bid to improve access and utilization of maternal and child health care services in the region, actors in public, private and civil society arenas at all levels have engaged in familiar circles towards service provisioning. Nevertheless, evidence from several SSA countries shows less utilization of some maternal and child health care services. The demand remains low for some services such as attendance of four antenatal visits as recommended by World Health Organization, delivery skilled birth attendants, postnatal care especially for newborns, child immunization, and use of modern contraceptives. The concern remains whether the less demand is influenced by supply-side or demand-side factors. The personal, socio-cultural, economic, health systems related factors may condition a person’s demand choices regardless of the need for a particular health service. Improved access may not necessarily translate into utilization because of these interrelated determinants of demand. Therefore, policy-makers might need to turn to Sen’s capability approach viewpoint to gaze at how expanding people’s choices-especially poor women might help to improve the demand for maternal and child health services in SSA. Policy interventions may include pro-poor healthcare service provisioning through public financing, improving women’s education, improving women’s access to information, etc. However, a multi-sectoral approach is necessary for addressing all demand determinants at all levels and the interventions should be context-specific.
Highlights
According to World Health Organization (WHO), an estimation of about 66% (201,000) maternal deaths, which are more than half of the global maternal deaths (303,000), were experienced in Sub-Saharan Africa by the year 2015
The fertility rate is still comparatively high in this region, but it has gradually reduced from 6.3 in 1990 to about 4.9 births per woman in 2016 [3]. These reductions in Maternal Mortality Ratio (MMR), under-five child mortality ratio and the fertility rate could be attributed to improvements in accessibility and utilization of maternal and child health care services
The poor performance in the demand for maternal and child health care services is attributed to negative perceptions on health services among potential users, poor attitudes among service providers, poor quality of services, socio-cultural factors such as use of Traditional Birth Attendants (TBAs), geographic locations affecting mostly rural women, inequalities related to information access, and most importantly household poverty affecting women in the poorest quantile
Summary
According to World Health Organization (WHO), an estimation of about 66% (201,000) maternal deaths, which are more than half of the global maternal deaths (303,000), were experienced in Sub-Saharan Africa by the year 2015. The fertility rate is still comparatively high in this region, but it has gradually reduced from 6.3 in 1990 to about 4.9 births per woman in 2016 [3] These reductions in MMR, under-five child mortality ratio and the fertility rate could be attributed to improvements in accessibility and utilization of maternal and child health care services. These reductions have disproportionately been experienced among the poorest quintiles and even differently within countries in this region. Gynecology and Women’s Health Research Open Access Journal factors within the realms of demand and supply sides These factors may relate to the value people attach to the services available and about the context the services are availed.
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