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Choice of Service Facility for Maternal Care and Its Proximate Correlates

M. Sheikh Giash Uddin
Department of Statistics, Jagannath University, Dhaka-1100, Bangladesh

M. G. Kibria
Quantificatin and MIS Management Sciences for Health (MSH), H# 3, Road # 23B, Gulshan-1, Dhaka-1212

Abstract/ Executive Summary:

The aim of this paper is to investigate the association between provision of maternal care services and its differentials. The study used data from Bangladesh Demographic and Health Surveys. The analysis revealed that the socio-economic status of women has positive impact on the likelihood of seeking antenatal care and delivering birth at a health facility. Women who have secondary and above education, the preference of facility delivery was also high. The likelihood of preferring private sector relative to public sector for delivery care has been increasing over time. The women of richest quintile are 3.5 times more likely to prefer delivery at public facility relative to home than the poorest quintile. The women with secondary and above education are 4 times more likely to deliver their child birth at public facility relative to home. This paper concludes that more attention should be given to the determinants of reproductive health, associated with their interactions such as service provision to reduce maternal morbidity and to achieve the MDG for maternal mortality.

Keywords: Delivery Care, Service provision, Women education

Location: Bangladesh Demographic and Health Surveys, Bangladesh

Start Date:

End Date:

Program Area: Socio-economic and Policy

Non-commodity: Education, Management

Objectives:

To investigate the association between provision of maternal care services and its differentials.

Methodology:

In order to assess different indicators over the period, the study used a number of statistical tools including bi-variate and multivariate analyses. Socio-economic status was assessed by constructing a household ‘wealth index’ based on principal components method and household asset. Bi-variate analysis was used to investigate the choice of utilization of reproductive health service provision (e.g., public, private, NGO etc) in Bangladesh. This study used multinomial logistic regression model. The dependent variables are place of delivery, source of delivery care services. Each of the variables recoded into nominal (polychotomous) variable with 3 categories. The place of delivery care recoded as 1=Public facility, 2=Private facility, 3=Home respectively. The use of health services provision is expected to be influenced by demographic (place of residence, geographical division), social (women’s education), economic (wealth quintile) and programmatic (access to mass media and visit by field workers) factors. To control the influence of these variables, multivariate analysis with the main effects of selection of service provider and other variables was used to examine the preference of Bangladeshi women for selecting private sector for their health care services. A multinomial dependent variable required to make some notational adaptations. Let J represent the number of discrete categories of the dependent variable, where J ≥ 2. Now, consider random variable Z that can take on one of J possible values. If each observation is independent, then each Z_i is a multinomial random variable. Once again, we aggregate the data into populations each of which represents one unique combination of independent variable settings. Since each observation records one of J possible values for the dependent variable, Z, let y be a matrix with N rows (one for each population) and J -1 columns. For each population, y_ij represents the observed counts of the j^th value of Z_i. Similarly, π is a matrix of the same dimensions as y where each element π_ij is the probability of observing the j^th value of the dependent variable for any given observation in the ith population. The design matrix of independent variables, X, contains N rows and K +1 columns where K is the number of independent variables and the first element of each row, x_i0 = 1, the intercept. Let β be a matrix with K + 1 rows and J - 1 column, such that each element β_kj contains the parameter estimate for the k^th covariate and the j^th value of the dependent variable. For the multinomial logistic regression model, we equate the linear com ponent to the log of the odds of a j^th observation compared to the j^th observation. That is, we will consider the J^th category to be the omitted or baseline category, where logits of the first J - 1 categories are constructed with the baseline category in the denominator.

Source of Information: Bangladesh J. Sci. Res. 27 (2): 175-185, 2014 (December)

Article Link (Online Journal):

Funding Source:

Total Budget (Tk.) :

Achievement/Findings:

In Bangladesh maternal health care need is one of the nation’s public health priorities. This study reveals the choices and differentials of maternal services in Bangladesh. The findings showed facility deliveries are increasing but still low as expected to national goal (percentage of births attended by skilled providers would be 50% by 2015). It is important to note facility delivery is increasing more quickly in private sector facilities than in public sector facilities. This increment is heavily towards the higher educated and economically better off sections of the community. The analysis showed that maternal education, wealth quintile mass media access and place of residence significantly affect on choice of health facility. The overall findings seem to suggest the correlates of maternal care need to address in developing suitable program to meet the MDG 5. Given the low institutional delivery and high maternal mortality, there is a need to target the groups who do not use health services for delivery and address the barriers that exist.

Knowledge Management: Journal