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Does antenatal care matter in the use of skilled birth attendance in rural Africa: A multi-country analysis

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  • Adjiwanou, Vissého
  • LeGrand, Thomas
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    Abstract

    While the importance of antenatal care for maternal and child health continues to be debated, several researchers have documented its impact on intermediate variables affecting survival such as birth weight. These studies have also highlighted the problems of causality that are typically not taken into account when estimating the effects of antenatal care on skilled birth attendance. In this study, we revisit this relation in the rural areas of four countries: Ghana, Kenya, Uganda and Tanzania. Using a structural equation modeling approach that corrects for endogeneity, in all four countries we find that the usual simpler probit (or logit) models tend to underestimate the direct effect of antenatal care on skilled birth attendance. Furthermore, in two of the countries, this estimated effect is mediated by the range of services offered to women during antenatal care. These results suggest that governments and NGOs should place more importance on the role of antenatal care providers and on the services they offer, in efforts to promote skilled birth attendance.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 86 (2013)
    Issue (Month): C ()
    Pages: 26-34

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    Handle: RePEc:eee:socmed:v:86:y:2013:i:c:p:26-34

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    Related research

    Keywords: Antenatal care; Skilled birth attendance; Quality of care; Endogeneity; Structural equation modeling; Africa; Ghana; Uganda; Kenya; Tanzania;

    References

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    1. Shelah Bloom & David Wypij & Monica Gupta, 2001. "Dimensions of women’s autonomy and the influence on maternal health care utilization in a north indian city," Demography, Springer, vol. 38(1), pages 67-78, February.
    2. Sepehri, Ardeshir & Sarma, Sisira & Simpson, Wayne & Moshiri, Saeed, 2008. "How important are individual, household and commune characteristics in explaining utilization of maternal health services in Vietnam?," Social Science & Medicine, Elsevier, vol. 67(6), pages 1009-1017, September.
    3. Øystein Kravdal, 2002. "Education and fertility in sub-Saharan africa: Individual and community effects," Demography, Springer, vol. 39(2), pages 233-250, May.
    4. Theodore Joyce, 1990. "Self-Selection, Prenatal Care, and Birthweight Among Blacks, Whites and Hispanics in New York City," NBER Working Papers 3549, National Bureau of Economic Research, Inc.
    5. Gage, Anastasia J., 2007. "Barriers to the utilization of maternal health care in rural Mali," Social Science & Medicine, Elsevier, vol. 65(8), pages 1666-1682, October.
    6. James Cramer, 1995. "Racial and Ethnic Differences in Birthweight: The Role of Income and Financial Assistance," Demography, Springer, vol. 32(2), pages 231-247, May.
    7. De Allegri, Manuela & Ridde, Valéry & Louis, Valérie R. & Sarker, Malabika & Tiendrebéogo, Justin & Yé, Maurice & Müller, Olaf & Jahn, Albrecht, 2011. "Determinants of utilisation of maternal care services after the reduction of user fees: A case study from rural Burkina Faso," Health Policy, Elsevier, vol. 99(3), pages 210-218, March.
    8. Guliani, Harminder & Sepehri, Ardeshir & Serieux, John, 2012. "What impact does contact with the prenatal care system have on women’s use of facility delivery? Evidence from low-income countries," Social Science & Medicine, Elsevier, vol. 74(12), pages 1882-1890.
    9. Amooti-Kaguna, B. & Nuwaha, F., 2000. "Factors influencing choice of delivery sites in Rakai district of Uganda," Social Science & Medicine, Elsevier, vol. 50(2), pages 203-213, January.
    10. Guilkey, David K. & Popkin, Barry M. & Akin, John S. & Wong, Emelita L., 1989. "Prenatal care and pregnancy outcome in Cebu, Philippines," Journal of Development Economics, Elsevier, vol. 30(2), pages 241-272, April.
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