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How women’s education and autonomy affect their use of maternal health services in nigeria.

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HOW WOMEN’S EDUCATION AND AUTONOMY AFFECT THEIR USE OF MATERNAL HEALTH SERVICES IN NIGERIA.

Background:

Maternal mortality is a major public health problem in low- and middleincome countries. Most of the maternal deaths could be prevented if there is adequate and timely use of maternal health care services by women. Decision making power of women is one of the essential factors which have influence on maternal health care service utilization. This study aims to assess the association between women’s autonomy and maternal health care utilization among Nepalese women. Methods: This study was based on Nepal Demographic Health Survey (NDHS), 2011 which is a nationally representative, population based household survey. The total of 4,148 women was analyzed in this study. Utilization of maternal health care services was measured in terms of number of ANC visits, timing of start of ANC visit, skilled attendants during ANC visits, place of delivery and skilled attendants during delivery. Similarly, women’s autonomy was assessed in terms of decision making regarding health care, large household purchases, visiting friends or relatives and spending money earned by husbands. The association of various socio-demographic variables, women’sm autonomy and maternal health care utilization was analyzed using Pearson’s chi-square

Table of contents
1. INTRODUCTION………………………………………………………………………………………….. 1
2. LITERATURE REVIEW………………………………………………………………………………… 3
2.1 Maternal health care and utilization……………………………………………………………… 3
2.1.1 Maternal Health care services in Nepal…………………………………………………… 3
2.1.2 Antenatal care services…………………………………………………………………………. 3
2.1.2 Delivery care services ………………………………………………………………………….. 5
2.1.3 Postnatal care services………………………………………………………………………….. 6
2.2 Women’s autonomy…………………………………………………………………………………. 10
2.2.1 Concept of women’s autonomy……………………………………………………………. 10
2.2.2 Factors associated with women’s autonomy………………………………………….. 11
2.2.2.1 Age and family structure……………………………………………………………….. 11
2.2.2.2 Literacy/Education ………………………………………………………………………. 11
2.2.2.3 Employment and occupation …………………………………………………………. 12
2.2.2.4 Income ……………………………………………………………………………………….. 12
2.2.2.5 Culture and religion …………………………………………………………………….. 13
2.2.3 Women’s autonomy and maternal health care utilization………………………… 14
3. AIMS OF THE STUDY………………………………………………………………………………… 19
4. MATERIALS AND METHODS ……………………………………………………………………. 20
4.1 Study area ………………………………………………………………………………………………. 20
4.2 Data source …………………………………………………………………………………………….. 21
4.3 Data Sampling and sample size …………………………………………………………………. 21
4.4 Study questionnaires………………………………………………………………………………… 23
4.5 Measurements of variables ……………………………………………………………………….. 23
4.5.1 Outcome variable ………………………………………………………………………………. 23
4.5.1.1 Number of ANC visit…………………………………………………………………….. 23
4.5.1.2 Timing of start of ANC………………………………………………………………….. 24
4.5.1.3 Attendants during ANC…………………………………………………………………. 24
4.5.1.4 Place of delivery ………………………………………………………………………….. 24
4.5.1.5 Assistance during delivery…………………………………………………………….. 25
4.5.2 Variables related with women’s autonomy……………………………………………. 25
4.5.2.1 Women’s autonomy ……………………………………………………………………… 25
4.5.2.2 Level of autonomy………………………………………………………………………… 25
4.5.3 Socio-demographic variables………………………………………………………………. 25
4.6 Statistical analysis……………………………………………………………………………………. 26
4.6.1 Descriptive statistics…………………………………………………………………………… 26
4.6.2 Logistic regression analysis ………………………………………………………………… 27
5. RESULTS……………………………………………………………………………………………………. 28
5.1 Socio-demographic characteristics of women ……………………………………………… 28
5.2 Distribution of outcome and autonomy variables…………………………………………. 29
5.3 Socio-demographic variables and maternal health care utilization …………………. 31
5.3.1 Socio-demographic variables and number of ANC visits………………………… 31
5.3.2 Socio-demographic variables and timing of start of ANC……………………….. 32
5.3.3 Socio-demographic variables and place of delivery ……………………………….. 33
5.4 Women’s autonomy and maternal health care utilization ……………………………… 35
5.4.1 Women’s autonomy and number of ANC visits…………………………………….. 35
5.4.2 Women’s autonomy and timing of start of ANC……………………………………. 36
5.4.3 Women’s autonomy and place of delivery…………………………………………….. 37
5.5 Regression analysis for maternal health care utilization ……………………………….. 38
5.5.1 Women’s autonomy and number of ANC visits…………………………………….. 38
5.5.2 Women’s autonomy and timing of start of ANC……………………………………. 39
5.4.3 Women’s autonomy and attendants during ANC visits…………………………… 41
5.4.4 Women’s autonomy and place of delivery…………………………………………….. 43
5.4.5 Women’s autonomy and attendants during delivery……………………………….. 44
6. DISCUSSIONS ……………………………………………………………………………………………. 46
6.1 Summary of findings ……………………………………………………………………………….. 46
6.2 Comparison with earlier studies ………………………………………………………………… 46
6.2.1 Prevalence of maternal health care services…………………………………………… 46
6.2.2 Women’s autonomy …………………………………………………………………………… 47
6.2.3 Socio-demographic factors and maternal health care utilization ………………. 48
6.2.4 Women’s autonomy and maternal health care utilization………………………… 49
6.3 Strength and weakness of study…………………………………………………………………. 51
7. CONCLUSION AND FUTURE IMPLICATIONS…………………………………………… 52
Acknowledgements ………………………………………………………………………………………….. 53
References ………………………………………………………………………………………………………. 54
Appendix ………………………………………………………………………………………………………… 59

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