Utilization of maternity care services: a comparative study using DHS data.

Abstract

The factors predisposing women not to seek maternity care were investigated through data from Demographic and Health Surveys (DHS) conducted in Bolivia Egypt and Kenya in 1988-89. Outcomes studied were whether prenatal care was received a trained person attended the delivery and tetanus toxoid was received during pregnancy. Also examined were independent variables pertaining to service access socioeconomic status maternal age and parity contraceptive use history and twin birth. Expected were the higher percentages of births where women received prenatal care (45% in Bolivia 53% in Egypt and 77% in Kenya) than births that were attended (42% 35% and 50% respectively). The percent of births where tetanus toxoid was received during pregnancy was low in Bolivia and Egypt (20% and 12%) but 89% in Kenya. Multivariate analysis revealed risk factors that have been documented in other research. Rural residence conferred a risk of not receiving prenatal care of 1.4 in Kenya and 1.5 in Bolivia and Egypt while the lack of any education placed Bolivian women at an almost 3 times greater risk than their counterparts with 6 years or more of education and Egyptian women at a 1.6 times greater risk. The risk of not seeking maternity care was boosted by 1/4 in women in Bolivia and Egypt who were under 20 years of age in comparison to their counterparts 20-24 years of age. Bolivian women who had never used family planning were almost twice as likely not to seek prenatal care than former users of modern contraceptive methods while this factor increased the risk by 1/4 for Egyptian women. Women in these 2 countries who were experiencing a first or twin birth were on the other hand significantly more likely to seek care. In Kenya there were many more significant associations between these indicators and the risk of having an unattended birth.