ABSTRACT
Introduction: Antenatal care (ANC) is one of the pillars of maternal and child health programs aimed at preventing and reducing maternal and child morbidity and mortality. This study aims to identify the factors associated with ANC use, considering both health care demand and supply factors in the single analysis. Methods: We used data from the endline survey conducted to evaluate the impact of the performance-based financing (PBF) program in Burkina Faso in 2017. This study was a blocked-by-region cluster random trial using a pre-post comparison design. The sample was derived in a three-stage cluster sampling procedure. Data collection for the endline surveys included a household survey and a facility-based survey. Women of childbearing age who gave birth at least once in the past 2 years prior to this survey and residing in the study area for more than 6 months were included in this study. Multilevel statistical techniques were used to examine individual and contextual effects related to health care demand and supply simultaneously and thus measure the relative contribution of the different levels to explaining factors associated with ANC use. Results: The working women were five times [odd ratio (OR): 5.41, 95% confidence intervals (CI) 4.36-6.70] more likely to report using ANC services than the women who were not working (OR: 5.41, 95% CI 4.36-6.70). Women living in a community with high poverty concentration were 32.0% (OR: 0.68, 95% CI 0.50-0.91) less likely to use ANC services than those in a community with low poverty concentration. Women living in a community with a medium concentration of women's modern contraceptive use were almost two times (OR: 1.88, 95% CI 1.70-2.12) more likely to use ANC services than those living in a community with a low concentration of women's modern contraceptive use. Women living in the health area where the level of ANC quality was high were three times (OR: 2.96, 95% CI 1.46-6.12) more likely to use ANC services than those in the health area where the ANC quality was low. Conclusion: Policies that increase the opportunity for improving the average ANC quality at the health facility (HF), the level of women's modern contraceptive use and women employment would likely be effective in increasing the frequency of use of antenatal services.
ABSTRACT
BACKGROUND: The main aim of the study is to examine whether women in Mdantsane are accessing and using maternal health care services. Accessibility of maternal health care facilities is important in ensuring that lives are saved through the provision and use of essential maternal services. Therefore, access to these health care services directly translates to use--that is, if women cannot access life-saving maternal health care services, then use of such services will be limited. FINDINGS: The study makes use of mixed methods to explore the main factors associated with access to and use of maternal health care services in Mdantsane. For the quantitative approach, we collected data using a structured questionnaire. A sample of 267 participants was selected from health facilities within the Mdantsane area. We analyzed this data using bivariate and multivariate models. For the qualitative approach, we collected data from health care professionals (including nurses, doctors, and maternal health specialists) using one-on-one interviews. The study found that women who were aged 35-39, were not married, had secondary education, were government employees, and who had to travel less than 20 km to get to hospital were more likely to access maternal health services. The qualitative analysis provided the insights of health care professionals regarding the determinants of maternal health care use. Staff shortages, financial problems, and lack of knowledge about maternal health care services as well as about the importance of these services were among the major themes of the qualitative analysis. CONCLUSION: A number of strategies could play a big role in campaigning for better access to and use of maternal health services, especially in rural areas. These strategies could include (a) the inclusion of the media in terms of broadcasting information relating to maternal health services and the importance of such services, (b) educational programs aimed at enhancing the literacy skills of women (especially in rural areas), (c) implementing better policies that are aimed at shaping the livelihoods of women, and (d) implementing better delivery of maternal health care services in rural settings.
