Factors associated with maternal health seeking and utilization

Considering the achievement of Millennium Development Goals 5, the targets of Bangladesh is to reduce the maternal mortality rate into 143/100,000. At present, one third of pregnant women don't receive antenatal care. More than 70% of births took place at home. Only 29 percent of mothers receive postnatal care from a medically trained provider within 42 days after delivery. The aim of the study is to understand the barriers to household decision on obtaining maternal health care services. This is a qualitative study with phenomenological approach. The data collection process is guided through FGD, and in-depth interview. The findings show that careless about pregnancy, workload and the care of other children are viewed as reasons for poor adherence to ANC and delivery care. Mothers-in-law play an influential role in the uptake of ANC as well as delivery care in Bangladesh. Women prefer same sex health care professionals and there is no need to go for postnatal check-up when everything is normal. Decision-making is recognized as a complex process entwined with local belief systems and social relationships. Mothers, mothers-in-law, other female relatives, friends and neighbors are trustworthy sources of information in Bangladesh and play important role in decision making process.

Family planning is generally acknowledged as an important component of the reproductive health agenda and a necessity in all programs and policies geared towards the realization of safe motherhood. Several studies have established that most maternal deaths occur in the postpartum period. This paper therefore aims to contribute to existing knowledge on the factors affecting the adoption of PPFP, with special emphasis on examining how influential the women’s contact with maternal health services (antenatal care, delivery in a health facility and postnatal care) had been on adoption of contraception in the postpartum period. The analysis was based on the data from the Women’s Questionnaire and the calendar data from the 2008 Nigeria Demographic and Health Survey (NDHS). The use of maternal health services (ANC visits and timing of postnatal check-up) is significantly associated with the use of a modern method of contraception during the postpartum period. Other significant predictors of the use of a modern method in the postpartum period include region, education, the household wealth index, and exposure to family planning messages. The findings suggest that contraceptive use among postpartum women will increase substantially if more women use maternal health care services, especially for antenatal care and postnatal care.

In Bangladesh, women dying for maternal causes remain high. Women face long distance and significant transportation cost to deliver at hospital. To reduce barriers, government introduced demand-side financing program that gives transportation allowance for antenatal, delivery, complication management and postnatal care. A total of 3300 mothers aged 18-49 years given birth preceding year of survey were interviewed in 2010. The self-reported distance and round trip transportation cost from residence to the health facility was recorded. Only 53% women received ANC, 20% delivery and 10% received PNC. On average women travelled six kilometers for ANC and PNC but eight kilometers for complication care or delivery. Majority women used rickshaw or human powered van to reach health facility. On average women spent taka 100 (US$1.4) for ANC, taka 432 (US$6) for delivery and taka 132 (US$1.83) for PNC. For each additional kilometer, cost increased by taka 9 (US$0.12) for ANC, taka 30 (US$0.44) for delivery and taka 7 (US$0.11) for PNC. Currently a flat rate of taka 100 (US$1.4) for each is given; based on findings, the program should reconsider the transportation allowance.

The main aim of this paper is to assess the impact of at least one maternal healthcare service from three core components (antenatal care, institutional delivery, postnatal care) on contraceptive use. Data from the third wave of cross-sectional District Level Household Survey (2007-08) that covered 87,564 ever-married women aged 15-44 years in Uttar Pradesh have been analyzed. Results from the propensity score matching show that effects of utilizing at least one MH service (treatment) on contraceptive use (outcome) is statistically significant. The correlation coefficient among unobservable factors is also found to be significant. It indicates that variable for treatment variable created a selection bias while it was taken as one of the independent variables to predict likelihood of using a contraceptive method. Biprobit analysis shows that effects of using at least one MH service are positive and significant on likelihood of using a FP method. Likelihood of using a FP method also significantly varies by intensity of MCH services utilization and available community level factors. Reproductive health managers may use such dividends of utilization of MCH services in making family planning program strategies in rural Uttar Pradesh.