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Maternal Health Care Utilization and Subsequent Contraceptive Use

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Findings from research conducted using secondary data from Kenya and Zambia to determine if there is a causal relationship between maternal health care utlization and susequent contraceptive use.

Published in: Health & Medicine
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Maternal Health Care Utilization and Subsequent Contraceptive Use

  1. 1. Is There a Causal Relationship Between Maternal Health Care Utilization and Subsequent Contraceptive Use?: Evidence from Kenya and Zambia Mai Do and David Hotchkiss Tulane University
  2. 2. Background <ul><li>Service integration receiving increased attention from governments and donors as way of improving efficiency and access to services </li></ul><ul><li>Several reasons why use of maternal health services might influence post-partum contraceptive use </li></ul><ul><li>Few studies have examined family planning (FP) within the context of reproductive health service delivery </li></ul><ul><ul><li>Mixed evidence on linkages between maternal health care (ANC, delivery, and PNC) and post-partum FP </li></ul></ul>
  3. 3. Research questions <ul><li>Is post-partum modern FP method use related to the use of ANC and PNC relating to the index childbirth? </li></ul><ul><li>If so, what can be said about the linkages between these services? </li></ul>
  4. 4. Data <ul><li>Most recent DHS: 2008-09 in Kenya and 2007 in Zambia </li></ul><ul><li>Selected Kenya and Zambia because: </li></ul><ul><ul><li>DHS within the last three years </li></ul></ul><ul><ul><li>DHS included a birth and contraceptive calendar </li></ul></ul><ul><ul><li>Substantial contraceptive use among married and cohabiting women </li></ul></ul><ul><li>Study sample: married and cohabiting women who had a live birth within five years of the survey </li></ul><ul><ul><li>Kenya: 3,667 women </li></ul></ul><ul><ul><li>Zambia: 3,587 women </li></ul></ul>
  5. 5. Methods (1) <ul><li>Statistical method: Cox proportional hazard model </li></ul><ul><li>Dependent variable: duration (months) from childbirth to modern contraceptive adoption </li></ul>
  6. 6. Methods (2) <ul><li>Independent variable: ANC and PNC service intensity score, constructed from 6 questions </li></ul><ul><ul><li>Timing of first ANC visit, if any </li></ul></ul><ul><ul><li>Number of ANC visits (4 or more) </li></ul></ul><ul><ul><li>Received tetanus vaccination </li></ul></ul><ul><ul><li>Received ANC from trained provider </li></ul></ul><ul><ul><li>Whether specified procedures were carried out during ANC visit (measuring weight and height, blood pressure, taking urine and blood sample, breastfeeding counseling, being told about signs of complications) </li></ul></ul><ul><ul><li>Received PNC from trained provider </li></ul></ul>
  7. 7. Methods (3) <ul><li>Main control variables </li></ul><ul><ul><li>Knowledge of contraceptive methods </li></ul></ul><ul><ul><li>Woman visited and talked about FP with a field worker last 12 months </li></ul></ul><ul><ul><li>Woman visited and talked about FP at a health facility last 12 months </li></ul></ul><ul><ul><li>Desire for more children </li></ul></ul><ul><ul><li>Prior use of modern contraceptive methods </li></ul></ul><ul><ul><li>Recall of FP messages in the mass media </li></ul></ul><ul><li>Tests performed of exogeneity of ANC and PNC service intensity score </li></ul>
  8. 8. Country findings: Kenya 46% adopted modern FP post-partum * p<.05; ** p<.01; *** p<.001 Controls for: socio-demographic characteristics, durations of breasfeeding and amenorrrhea Characteristic Distribution ANC/PNC service intensity Post-partum modern FP use % or mean (s.e.) Coef. (s.e.) Hazard ratio (s.e.) ANC/PNC service intensity (range: -2.75; .90) 0 (1) 1.11 (.04)* Age at first birth 19.2 (3.4) .02 (.00)** - Desire for more children (ref=No) 49.7 - .88 (.05)* Number of modern methods known (knowledge) 6.7 (2.6) - 1.07 (.01)*** Visited and talked about FP at health facility last 12 months (ref=No) 20.9 - 1.21 (.07)** Heard FP messages on the radio last few months (ref=No) 71.6 - 1.15 (.08)*
  9. 9. Kenya: Influences of ANC and PNC services on post-partum modern FP use * p<.05; ** p<.01; *** p<.001 Controls for all women ’s characteristics mentioned before. Characteristic Distribution Post-partum modern FP use % or mean (s.e.) Hazard ratio (s.e.) ANC service intensity (range: -2.72; .88) .1 (.9) 1.10 (.04)** PNC service intensity (range: 0; 2.00) .6 (.6) 1.03 (.05)
  10. 10. Country findings: Zambia 45.9% adopted modern FP post-partum * p<.05; ** p<.01; *** p<.001 Controls for: socio-demographic characteristics, durations of breasfeeding and amenorrrhea Characteristic Distribution ANC/PNC service intensity Post-partum modern FP use % or mean (s.e.) Coef. (s.e.) Hazard ratio (s.e.) ANC/PNC service intensity (range: -4.07; 1.27) 0 (1) 1.08 (.03)* Age at first birth 18.6 (3.0) .04 (.01)* - Desire for more children (ref=No) 66.4 - .95 (.06) Number of modern methods known (knowledge) 6.8 (2.1) - 1.04 (.01)** Visited and talked about FP by a field worker last 12 months (ref=No) 7.8 - 1.20 (.10)* Visited and talked about FP at health facility last 12 months (ref=No) 32.4 - 1.23 (.07)***
  11. 11. Zambia: Influences of ANC and PNC services on post-partum modern FP use * p<.05; ** p<.01; *** p<.001 Controls for all women ’s characteristics mentioned before. Characteristic Distribution Post-partum modern FP use % or mean (s.e.) Hazard ratio (s.e.) ANC service intensity (range: -4.06; 1.26) .0 (.99) 1.08 (.03)* PNC service intensity (range: 0; 2.00) .6 (.7) .95 (.04)
  12. 12. Conclusions <ul><li>Evidence of MCH service use as mediator for individual characteristics to influence post-partum modern FP use </li></ul><ul><ul><li>Results suggest that maternal health care use and FP use are not influenced by common unobserved factors </li></ul></ul><ul><ul><li>Several observed individual factors influence maternal health care use, which then influence FP use </li></ul></ul><ul><li>Evidence that ANC, not PNC, service intensity related to post-partum modern FP use </li></ul><ul><ul><li>Need for service integration, esp. in public sector </li></ul></ul><ul><ul><li>PNC may be among the weakest aspects of RH program </li></ul></ul>
  13. 13. Limitations <ul><li>Not generalizable to all women of childbearing age </li></ul><ul><ul><li>Only married, cohabiting women included in the sample </li></ul></ul><ul><li>Possible endogeneity between FP use and exposure to FP messages in the media and visit by FP a field worker </li></ul><ul><li>No data on community-level and programmatic factors </li></ul>
  14. 14. <ul><li>MEASURE Evaluation PRH is a MEASURE project funded by </li></ul><ul><li>the United States Agency for International Development </li></ul><ul><li>(USAID) through Cooperative Agreement GHA-A-00-08-00003- </li></ul><ul><li>00 and is implemented by the Carolina Population Center at </li></ul><ul><li>the University of North Carolina at Chapel Hill in partnership </li></ul><ul><li>with Futures Group International, Management Sciences for </li></ul><ul><li>Health, and Tulane University. Views expressed in this </li></ul><ul><li>presentation do not necessarily reflect the views of USAID or </li></ul><ul><li>the U.S. Government. MEASURE Evaluation PRH supports </li></ul><ul><li>improvements in monitoring and evaluation in population, </li></ul><ul><li>health and nutrition worldwide. </li></ul>

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