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Article
Publication date: 7 June 2011

Patience Aseweh Abor, Gordon Abekah‐Nkrumah, Kojo Sakyi, Charles K.D. Adjasi and Joshua Abor

The study aims to examine the socio‐economic determinants of maternal health services utilization in Ghana.

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Abstract

Purpose

The study aims to examine the socio‐economic determinants of maternal health services utilization in Ghana.

Design/methodology/approach

Probit and ordered probit models are employed in this study.

Findings

The results generally indicate that most women in Ghana undertake the required visits for antenatal services and also take both doses of the tetanus toxoid vaccine as required by World Health Organization. However, the results show low levels of usage in terms of the other maternal health care services (i.e. prenatal care, delivery at a health facility, and postnatal care). There is clearly an urgent need to develop innovative strategies that will help upscale intervention especially for improvement in the use of these services by women in Ghana. The regression results reveal that utilization of maternal health services and intensity of use of antenatal services are influenced by age of mother, type of birth, education of mother, ethnicity, economic status, geographic location, residence, and religious affiliation. Obviously, this suggests that more than medical factors are responsible for the differences in the use of maternal health services by women in Ghana as well as the decision on the number of visits to undertake with respect to antenatal visits.

Originality/value

The findings of this study have important implications for health policy formulation targeted at improving maternal health care service utilization.

Details

International Journal of Social Economics, vol. 38 no. 7
Type: Research Article
ISSN: 0306-8293

Keywords

Article
Publication date: 8 July 2014

Gordon Abekah-Nkrumah, Marta Guerriero and Purnima Purohit

Traditionally, the role of technology on health services has been argued from the supply side. The purpose of this paper is to use a demand side perspective to examine the…

Abstract

Purpose

Traditionally, the role of technology on health services has been argued from the supply side. The purpose of this paper is to use a demand side perspective to examine the effect of Information and Communication Technologies (ICTs) on the use of maternal health services in Ghana.

Design/methodology/approach

Study used data from the 2008 Ghana Demographic and Health Surveys and binary response regression models to examine the effect of women's access to ICTs on maternal healthcare utilization in Ghana. Three variables on maternal healthcare utilization were employed: use of contraception, antenatal care and place of delivery.

Findings

Results from the study show that the effect of the use of technology is both positive and significant. In particular, among the other ICTs (i.e. landline phone, listening to radio, watch television, color television in household, computer in household), the coefficients of mobile phone ownership tends to be consistently significant across all four reproductive health services. Therefore, ICTs have a good capacity to influence women's demand of health information. This needs to be taken into account when designing maternal health policies and interventions.

Originality/value

This is one of the few papers examining the effect of ICTs on utilization of maternal health services from the demand side compared to the popular supply side argument often found in the literature.

Details

International Journal of Social Economics, vol. 41 no. 7
Type: Research Article
ISSN: 0306-8293

Keywords

Article
Publication date: 4 October 2011

Gordon Abekah‐Nkrumah, Patience Aseweh Abor, Joshua Abor and Charles K.D. Adjasi

This paper aims to examine links between women's access to micro‐finance and how they use maternal healthcare services in sub‐Saharan Africa (SSA).

2006

Abstract

Purpose

This paper aims to examine links between women's access to micro‐finance and how they use maternal healthcare services in sub‐Saharan Africa (SSA).

Design/methodology/approach

The authors use theoretical and empirical literature to propose a framework to sustain and improve women's access to maternal healthcare services through micro‐financing.

Findings

It is found that improved access to micro‐finance by women, combined with education may enhance maternal health service uptake.

Research limitations/implications

The paper does not consider empirical data in the analysis. The authors advocate empirically testing the framework proposed in other SSA countries.

Social implications

It is important to empower women by facilitating their access to education and micro‐finance. This has implications for improving maternal healthcare utilization in SSA.

Originality/value

The paper moves beyond poor access to maternal health services in SSA and proposes a framework for providing sustainable solutions.

Details

International Journal of Health Care Quality Assurance, vol. 24 no. 8
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 21 September 2018

Ama Pokuaa Fenny, Derek Asuman, Aba Obrumah Crentsil and Doreen Nyarko Anyamesem Odame

The purpose of this paper is to assess the trends of socioeconomic-related inequalities in maternal healthcare utilization in Ghana between 2003 and 2014 and examine the…

Abstract

Purpose

The purpose of this paper is to assess the trends of socioeconomic-related inequalities in maternal healthcare utilization in Ghana between 2003 and 2014 and examine the causes of inequalities in maternal healthcare utilization in Ghana.

Design/methodology/approach

Data are drawn from three rounds of the Ghana Demographic and Health Survey collected in 2003, 2008 and 2014, respectively. The authors employ two alternative measures of socioeconomic inequalities in health – the Wagstaff and Erreygers indices – to examine the trends of socioeconomic inequalities in maternal healthcare utilization. The authors proceed to decompose the causes of inequalities in maternal healthcare by applying a recently developed generalized decomposition technique based on recentered influence function regressions.

Findings

The study finds substantial pro-rich inequalities in maternal healthcare utilization in Ghana. The degree of inequalities has been decreasing since 2003. The elimination of user fees for maternal healthcare has contributed to achieving equity and inclusion in utilization. The decomposition analysis reveals significant contributions of individual, household and locational characteristics to inequalities in maternal healthcare. The authors find that educational attainment, urban residence and challenges with physical access to healthcare facilities increase the socioeconomic gap in maternal healthcare utilization.

Originality/value

There is a need to target vulnerable women who are unlikely to utilize maternal healthcare services. In addition to the elimination of user fees, there is a need to reduce inequalities in the distribution and quality of maternal health services to achieve universal coverage in Ghana.

Details

International Journal of Social Economics, vol. 46 no. 2
Type: Research Article
ISSN: 0306-8293

Keywords

Article
Publication date: 4 March 2020

Arvind Kumar Yadav and Pabitra Kumar Jena

The present study delves into the health inequalities between the two most socially deprived groups namely Scheduled Tribes (STs) and Scheduled Castes (SCs) in rural India.

Abstract

Purpose

The present study delves into the health inequalities between the two most socially deprived groups namely Scheduled Tribes (STs) and Scheduled Castes (SCs) in rural India.

Design/methodology/approach

This study used health-specific three rounds of National Sample Survey Office (NSSO) unit-level data for analyses. Probit model has been used to predict the differences in access to maternal healthcare services. Blinder–Oaxaca decomposition method is used to explore the inequality in health of rural population in India and assess the estimated relative contribution of socioeconomic and demographic factors to inequalities in maternal health.

Findings

The study establishes that STs women often perform poorly compared to SCs in terms of maternal health such as antenatal care, postnatal care and institutional delivery. Blinder–Oaxaca decomposition method shows that there exist health inequalities between STs and SCs women. Difference in household income contributes 21–34 percent and women's education 19–24 percent in the gap of utilization of maternal healthcare services between SCs and STs women. A substantial part of this difference is contributed by availability of water at home and geographical region. Finally, the study offers some policy suggestions in order to mitigate the health inequalities among socially marginalized groups of SCs and STs women in rural areas.

Originality/value

This study measures and explains inequalities in maternal health variables such as antenatal care, postnatal care and institutional delivery in rural India. Research on access to maternal healthcare facilities is needed to improve the health of deprived sections such as STs and SCs in India. The results of this study pinpoint the need for public health decision-makers in India to concentrate on the most deprived and vulnerable sections of the society. This study thus makes a detailed and tangible contribution to the current knowledge of health inequalities between the two most deprived social groups, i.e., SCs and STs.

Details

International Journal of Health Care Quality Assurance, vol. 33 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 9 December 2014

Keitshokile Dintle Mogobe, Sunanda Ray, Farai Madzimbamuto, Mpho Motana, Doreen Ramogola-Masire, Goabaone Rankgoane, Raina Phillips, Habte Dereje and Mosidi Mokotedi

– The purpose of this paper is to identify organisational, technical and individual factors leading to maternal deaths in non-citizen women in Botswana.

Abstract

Purpose

The purpose of this paper is to identify organisational, technical and individual factors leading to maternal deaths in non-citizen women in Botswana.

Design/methodology/approach

A sub-analysis was conducted comparing non-citizen women to citizens in a case record review of maternal deaths in 2010. Feedback on the results to health professionals was provided and their comments were noted.

Findings

In total, 19.6 per cent of 56 case notes reviewed to establish contributory factors to maternal deaths were in non-citizens. This is lower than health professionals perceptions that most maternal deaths are in non-citizens. Non-citizens were significantly less likely to have been tested for HIV and less likely to have received antenatal care, so did not receive interventions to prevent transmission of HIV to their infants or anti-retroviral therapy. They were more likely than citizens to have miscarried or delivered before 28 weeks gestational age at death. Delays in seeking health care were a major contributory factor to death.

Research limitations/implications

Incomplete record keeping and missing details, with 30 per cent of the notes of maternal deaths missing, a common problem with retrospective case-note studies.

Practical implications

Botswana is unlikely to meet Millennium Development Goal five target to reduce the maternal mortality ratio by 75 per cent. To make progress non-citizens must be given the same rights to access maternal health services as citizens. Rationing healthcare for non-citizens is a false economy since treatment of subsequent obstetric emergencies in this group is expensive.

Originality/value

Discrimination against non-citizen women in Botswana, by denying them free access to maternal health services, extends into loss of life because of delays in seeking healthcare especially for obstetric emergencies.

Details

International Journal of Migration, Health and Social Care, vol. 10 no. 4
Type: Research Article
ISSN: 1747-9894

Keywords

Article
Publication date: 22 March 2013

Dipty Nawal and Srinivas Goli

The purpose of this paper is to quantify inequalities in utilization of maternal health care services and measure the relative contribution of different factors affecting…

Abstract

Purpose

The purpose of this paper is to quantify inequalities in utilization of maternal health care services and measure the relative contribution of different factors affecting it in the context of Nepal.

Design/methodology/approach

The paper uses data from the latest round of the Nepal Demographic and Health Survey. Two stages of stratified cluster samplings were used. A total of 13,200 women aged 15-49 were interviewed.

Findings

Results of concentration index estimates in three selected indicators suggest considerable inequalities in maternal health care utilization. The decomposition analyses indicate that the critical factors contributing to inequalities in <3 antenatal care visits are poor economic status of households (32 percent) and women (23 percent) and their partners’ illiteracy (23 percent). However, in case of no institutional delivery, apart from the poor economic status of household (51 percent) and women's illiteracy (16 percent), the rural place of residence (21 percent) has emerged as critical factors contributing to inequalities. In case of no postnatal care within a day, birth order (21 percent) becomes a significant factor, next to the poor economic status of the household (41 percent) in terms of the relative contribution to total inequalities.

Practical implications

Policies and program targeting maternal health interventions need to consider equity with efficiency in utilization of maternal health care services, and further to achieve the targets of millennium development goal 5 in Nepal.

Originality/value

This study is an innovative effort to estimate inequalities in maternal health care services in the context of Nepal by using inequality decomposition model. For the first time, this study estimates the relative contribution of different socioeconomic factors contributing to inequalities in maternal health care services in Nepal.

Details

Ethnicity and Inequalities in Health and Social Care, vol. 6 no. 1
Type: Research Article
ISSN: 1757-0980

Keywords

Open Access
Article
Publication date: 16 February 2021

Jahirul Hushen, Arpaporn Powwattana, Chockchai Munsawaengsub and Sukhontha Siri

This study aimed to identify the proportion and factors influencing the use of maternal health services (MHS) in rural Thawang, Rolpa, Nepal.

Abstract

Purpose

This study aimed to identify the proportion and factors influencing the use of maternal health services (MHS) in rural Thawang, Rolpa, Nepal.

Design/methodology/approach

This was a community-based cross-sectional study conducted among 417 mothers who had given birth in the previous two years. Bivariate and multivariate logistic regression was applied to identify associations and predictors.

Findings

The results showed that the use of maternal health services was 50.8%. Adjusting for all other factors in the final model, age group 25–30 years (AOR: 2.30; 95% CI: 1.199–4.422), spouse communication (AOR: 7.31; 95% CI: 2.574–20.791), high accessibility (AOR: 2.552, 95% CI: 1.402–4.643) and high affordability (AOR: 10.89; 95% CI: 4.66–25.445) were significant predictors.

Research limitations/implications

This is a community-based cross-sectional study, and hence cannot establish causal relationships. The research was conducted in a limited rural area mid-Western Nepal, and this may limit the generalization of results to other settings of the country.

Practical implications

This research supports to local level government and district health authority to develop and implement need based action to increase maternal health service in the local context.

Originality/value

Underutilization of maternal health services is the result of socioeconomic dynamics, poor access to health services and other physical developments. To increase utilization of maternal health services in rural areas, there is a need to tackle the root cause of health inequality such as reducing poverty, increasing female education, involving women in employment and increasing access to health as a priority development agenda by government authorities. This research supports local level government and district health authorities to develop and implement needs-based action to increase MHS in the local context.

Details

Journal of Health Research, vol. 36 no. 1
Type: Research Article
ISSN: 0857-4421

Keywords

Article
Publication date: 5 April 2013

Edward Nketiah‐Amponsah, Bernardin Senadza and Eric Arthur

The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.

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Abstract

Purpose

The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.

Design/methodology/approach

The paper utilizes the most recent Ghana Demographic and Health Survey (GDHS V) data. The dependent variable is the intensity of utilization (number) of antenatal care visits. Hence, the negative binomial regression is employed to investigate the socio‐economic and demographic correlates of the intensity of antenatal care utilization in Ghana.

Findings

The study finds that wealth status, age, ownership of health insurance (especially for rural women), educational attainment, birth order, religion and administrative region of residence are significant predictors of the intensity of antenatal care services utilization. In particular, the utilization rate increases in wealth status. The authors also found significant statistical relationship between residence and antenatal care utilization. This finding reinforces the differences in health facilities between the rural and urban areas of Ghana. The authors did not, however, find evidence for proxies for financial and physical access.

Research limitations/implications

The GDHS survey lacks data on the distance to the nearest health facility where ANC is sought and a variable for the price of ANC visit. Proxies had to be used to capture these variables.

Practical implications

The fact that ownership of health insurance in rural areas increases the number of ANC visits makes it imperative to intensify health insurance awareness and enrollment campaigns in the rural areas so as to bridge the rural‐urban gap in ANC utilization. Also, while the free maternal health care policy for expecting mothers is laudable, a minimum level of wealth is required to induce antenatal care visitations. This is because household wealth status still plays a major role even in a free maternal health regime.

Originality/value

A new finding of the paper is the significant effect that ownership of health insurance has on the utilization of ANC services among rural women. While generally rural women have a lower propensity to use ANC services compared to urban women, the intensity of usage of ANC services tends to increase for rural women who own health insurance.

Details

African Journal of Economic and Management Studies, vol. 4 no. 1
Type: Research Article
ISSN: 2040-0705

Keywords

Article
Publication date: 3 October 2019

Farah Shroff, Jasmit S. Minhas and Christian Laugen

Many low- and middle-income countries (LMICs) are struggling to reduce maternal mortality rates, despite increased efforts by the United Nations through the implementation…

Abstract

Purpose

Many low- and middle-income countries (LMICs) are struggling to reduce maternal mortality rates, despite increased efforts by the United Nations through the implementation of their Millennium Development Goals program. Industrialized nations, such as Canada, have a collaborative role to play in raising the global maternal health standards. The purpose of this paper is to propose policy approaches for Canadians and other Organization of Economic Cooperation and Development (OECD) nations who wish to assist in reducing maternal mortality rates.

Design/methodology/approach

Ten Canadian health experts with experience in global maternal health were interviewed. Using qualitative analytical methods, the authors coded and themed their responses and paired them with peer-reviewed literature in this area to establish a model for improving global maternal health and survival rates.

Findings

Findings from this study indicated that maternal health may be improved by establishing a collaborative approach between interdisciplinary teams of health professionals (e.g. midwives, family physicians, OB/GYNs and nurses), literacy teachers, agriculturalists and community development professionals (e.g. humanitarians with diverse linguistic and cultural backgrounds). From this, a conceptual approach was devised for elevating the standard of maternal health. This approach includes specifications by which maternal health may be improved, such as gender justice, women’s literacy, freedom from violence against women, food and water security and healthcare accessibility. This model is based on community health center (CHC) models that integrate upstream changes with downstream services may be utilized by Canada and other OECD nations in efforts to enhance maternal health at home and abroad.

Research limitations/implications

Maternal mortality may be reduced by the adoption of a CHC model, an approach well suited for all nations regardless of economic status. Establishing such a model in LMICs would ideally establish long-term relationships between countries, such as Canada and the LMICs, where teams from supporting nations would collaborate with local Ministries of Health, non-government organizations as well as traditional birth attendants and healthcare professionals to reduce maternal mortality.

Practical implications

All OECD Nations ought to donate 0.7 percent of their GDP toward international community development. These funds should break the tradition of “tied aid”, thereby removing profit motives, and genuinely contribute to the wellbeing of people in LMICs, particularly women, children and others who are vulnerable. The power of partnerships between people whose aims are genuinely focused on caring is truly transformative.

Social implications

Canada is not a driver of global maternal mortality reduction work but has a responsibility to work in partnership with countries or regions in a humble and supportive role. Applying a comprehensive and interdisciplinary approach to reducing maternal mortality in the Global South includes adopting a CHC model: a community development approach to address social determinants of health and integrating various systems of evidence-informed healthcare with a commitment to social justice. Interdisciplinary teams would include literacy professionals, researchers, midwives, nurses, family physicians, OB/GYNs and community development professionals who specialize in anti-poverty work, mediation/dialogue and education campaigns that emphasize the value of all people regardless of their gender, ethnicity, religion and income. Diasporic Canadians are invaluable members of these teams due to their linguistic and cultural knowledge as well as their enthusiasm for working with their countries of origin. Establishment of long-term partnerships of 5–10 years between a Canadian team and a region or nation in the Global South that is dedicated to reducing maternal mortality and improving women’s health are valuable. Canada’s midwifery education programs are rated as world leaders so connecting midwives from Canada with those of the Global South will facilitate essential transfer of knowledge such as using birth plans and other evidence-based practices. Skilled attendants at the birth place will save women’s lives; in most cases, trained midwives are the most appropriate attendants. Video link to a primer about this paper by Dr Farah Shroff: https://maa.med.ubc.ca/videos-and-media/.

Originality/value

There are virtually no retrievable articles that document why OECD nations ought to work with nations in the LMICs to improve maternal health. This paper outlines the reasons why it is important and explains how to do it well.

1 – 10 of over 3000