Article

Factors affecting the use of maternal health services in Madhya Pradesh state of India: A multilevel analysis

United Nations Population Fund, Bhopal, Madhya Pradesh-462013, India. .
International Journal for Equity in Health (Impact Factor: 1.71). 12/2011; 10(1):59. DOI: 10.1186/1475-9276-10-59
Source: PubMed

ABSTRACT Improving maternal health is one of the eight Millennium Development Goals. It is widely accepted that the use of maternal health services helps in reducing maternal morbidity and mortality. The utilization of maternal health services is a complex phenomenon and it is influenced by several factors. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The objective of this study was to estimate the effects of individual, community and district level characteristics on the utilisation of maternal health services with special reference to antenatal care (ANC), skilled attendance at delivery and postnatal care (PNC).
This study was designed as a cross sectional study. Data from 15,782 ever married women aged 15-49 years residing in Madhya Pradesh state of India who participated in the District Level Household and Facility Survey (DLHS-3) 2007-08 were used for this study. Multilevel logistic regression analysis was performed accounting for individual, community and district level factors associated with the use of maternal health care services. Type of residence at community level and ratio of primary health center to population and percent of tribal population in the district were included as district level variables in this study.
The results of this study showed that 61.7% of the respondents used ANC at least once during their most recent pregnancy whereas only 37.4% women received PNC within two weeks of delivery. In the last delivery, 49.8% mothers were assisted by skilled personnel. There was considerable amount of variation in the use of maternal health services at community and district levels. About 40% and 14% of the total variance in the use of ANC, 29% and 8% of the total variance in the use of skilled attendance at delivery and 28% and 8.5% of the total variance in the use of PNC was attributable to differences across communities and districts, respectively. When controlled for individual, community and district level factors, the variances in the use of skilled attendance at delivery attributed to the differences across communities and districts were reduced to 15% and 4.3% respectively. There were only marginal reductions observed in the variance at community and district level for ANC and PNC use. The household socio-economic status and mother's education were the most important factors associated with the use of ANC and skilled attendance at delivery. The community level variable was only significant for ANC and skilled attendance at delivery but not for PNC. None of the district level variables used in this study were found to be influential factors for the use of maternal health services.
We found sufficient amount of variations at community and district of residence on each of the three indicators of the use of maternal health services. For increasing the utilisation of these services in the state, in addition to individual-level, there is a strong need to identify and focus on community and district-level interventions.

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    • "These results are in agreement with previous studies from Ethiopia, where sociocultural characteristics, religion and family reasons can determine home deliveries [27,34,36-38]. Other studies from low- and middle-income countries are also consistent with our findings [12,39-41]. "
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    • "The components of ANC suggested in Nepal include: iron supplementation, blood and urine tests, at least two tetanus toxoid injections, measurement of blood pressure, intestinal parasite drugs and health education regarding their pregnancy [23]. The different components of ANC improve maternal and child health in different ways [24,25]. Iron supplementation reduces the proportion of women becoming anaemic by increasing haemoglobin up to 0.7gram/decilitre per week; screening for hypertension and proteinuria allows early detection and treatment for preeclampsia and reduces case fatality of this condition; screening for infection reduces fetal loss and maternal and infant morbidity, preterm and low birth weight babies. "
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    • "Likewise, mothers from higher socioeconomic households are also more likely to be aware of the benefits of obtaining postnatal care through different media such as television, and newspapers than their counterparts from low socioeconomic groups. This finding is similar to the findings from the India and Nepal where mothers from higher socioeconomic group attend postnatal services [12,13,34,40,41]. "
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