Maternal health-seeking behavior and child’s birth order: Evidence from Malawi, Uganda, and Zimbabwe

Factors influencing maternal health-seeking behavior before and shortly after birth have been widely studied, while the role of birth order in shaping these actions is infrequently examined. This study sought to examine the critical role played by a child’s birth order in altering the maternal health-seeking behavior of women in developing countries. The analysis uses the most recent rounds of the nationally representative standard Demographic and Health Survey for Malawi, Uganda, and Zimbabwe. The empirical analysis utilizes two-level random intercept logistic regression models to assess the potential influence of birth order on prenatal care utilization, birth in a health facility, and breastfeeding. We find that women in Malawi, Uganda, and Zimbabwe were 34.9%, 34.6%, and 43.5% respectively, less liable to complete more than four prenatal care visits for a fifth or later born child than they are for a first born child. Women in Malawi, Uganda, and Zimbabwe were 56.4%, 58.8%, and 77.2% respectively less liable to give birth to a fifth born child in a hospital facility. Also, women who seek prenatal care in Malawi were 50.9% less liable to experience a neonatal death. Also, in Malawi and Zimbabwe the odds of a child dying before reaching the age of one year were 23.7% and 41.6% respectively. Breastfeeding had a protective effect on child survival in all the countries. Overall, we found that women tend to make low investments in maternal health and child well-being for higher order births than they do for first order births. This suggests the need for providers to encourage and re-educate mothers on the importance of investments in maternal health inputs even for higher order births.