Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries

TLDR

Women’s socio‑economic status has received little attention in studies of maternal health service use, despite growing focus on service quality and access. This study investigates how women’s economic, educational, and empowerment status (the 3Es) relate to maternal health service utilization in developing countries. The authors fitted logistic regression models for modern contraception, antenatal care, and skilled birth attendance across 31 countries, then combined the results with meta‑analysis. Women’s economic, educational, and empowerment status are strongly linked to maternal health service use: poorer women are 94% less likely to have a skilled attendant, primary‑educated women up to five times more likely to use skilled birth attendance, and higher empowerment scores raise the odds of modern contraception, antenatal care, and skilled birth attendance by 31–82%.

Abstract

Background Relative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries. Methods/Principal Findings The analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth. Conclusions/Significance Efforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1), universal primary education (MDG 2), and women's empowerment (MDG 3).