By, Elizabeth Tenney, Public Health Intern at PMI
With the United Nations Sustainable Development Summit this past weekend, I thought maternal health would be a great focal point for this post. It’s one of the targets under Sustainable Development Goal 3, which aims to “ensure healthy lives and promote well-being for all at all ages.”(1)
Poor maternal care is a leading global development challenge, especially in Africa. This deficit accounts for about half of the world’s maternal deaths. There has been very little progress towards reducing maternal mortality, and most of these deaths are due to a lack of prenatal care coverage and skilled attendance at delivery.(2)
Determinants of maternal health services utilization in Uganda takes a close look at the predictors of utilization for maternal health services (MHS).(3) In other words, it investigates the factors that affect new and expectant mothers’ decisions to seek healthcare.
Andersen’s behavioral model of health service was used to examine these various factors. It states, “A family’s use of health services depends upon its (1) predisposition to use services, (2) ability to secure services, and (3) need for services.”(4)
The authors conclude that use of maternal health services in Uganda varies widely by demographic characteristics and socioeconomic status. Women with higher levels of education, in urban areas, and with a higher income were most likely to use the desirable maternal health services package. This package is characterized by four visits before the birth, assistance of skilled personnel during delivery, and a post-natal check-up within two days of delivery.
While I was not surprised that women from the higher end of the socioeconomic spectrum were most likely to use MHS, I was shocked to find that 90% of the women in the study fell into the category of the undesirable maternal health services package. In this category, women had no visits before delivery, did not have a skilled attendant during delivery, and did not receive a post-natal check up afterwards.
I found the cultural explanations very interesting, especially because they can vary from region to region. Regarding cultural values and norms, “Ugandan women adhere to very traditional birthing practices and believe that pregnancy is a test of endurance and maternal death is merely a sad but normal event.”(5) In some districts of Uganda, pregnancy and childbirth are areas where women command power and status. They can harness this power in order to gain status within their households and communities. In other areas of the country, women feel they have the most power during the birthing process and it gives them a sense of control that they may not have in other aspects of their lives. The article explains “in some Ugandan societies, women are considered to be strong and independent if they can handle the birthing process by themselves,”(6) which makes them less likely to use MHS.
Other determinants that could affect women’s decisions were found through a study from a rural district in Eastern Uganda.(7) It found eight independent factors that contribute to the likelihood of women to deliver in a health facility. Some of these include being of high socio-economic status, previous difficult delivery, having less than four children, access to transportation, and being able to make an autonomous decision to seek care.
In summary, the women who need the most attention are in the lower-income categories, have no education, and live in rural areas. Ugandan culture also poses a challenge to maternal health indicators. So, one should consider “the nature and scope of the population groups that are most affected”(8) before implementing an intervention.
These findings exemplify the inverse care law, where those who need the most care are the least likely to receive it. Generally speaking, countries that have made great progress in the area of maternal health have progressed in a similar manner. “Coverage has increased first among the urban rich, followed by the rural rich and the urban poor, with access among the rural poor the last to be achieved.”(9)
Palmetto Medical Initiative recognized the need for maternal health services in rural Masindi, Uganda and, in October of 2012, the Masindi-Kitara Medical Center opened the doors to its maternity center. The center provides new and expectant mothers with a labor and delivery room, recovery ward, and operating theaters.
- (Neal, 2015, p.1)
- (Rutaremwa, 2015)
- (Kehrer, 1972, p.125)
- (Rutaremwa, 2015, p.6)
- (Rutaremwa, 2015, p.6)
- (Rutaremwa, 2015)
- (Rutaremwa, 2015, p.7)
- (Neal, 2015, p.2)
Kehrer, B. (1972). A Behavioral Model of Families’ Use of Health Services/Paying the Doctor . Journal Of Human Resources , 7 (1), 125.
Neal. (2015, June 16). Universal health care and equity: evidence of maternal health based on an analysis of demographic and household survey data. International Journal for Equity in Health.
Rutaremwa. (2015, June 16). Determinants of maternal health services utilization in Uganda. BMC Health Services Research.