The influence of female education on maternal health care utilization in Zambia: a multilevel analysis
Date
2016
Authors
Sambo, Jairos Kepson
Journal Title
Journal ISSN
Volume Title
Publisher
University of Zambia
Abstract
Introduction: In most developing countries female education is considered the single most
important predictor of maternal health seeking behavior. The study seeks to analyze the
role of female education by establishing whether quantitative evidence provides the same
conclusions and additional neighborhood influences on maternal health seeking behavior.
The study examined female education association with maternal health seeking behavior,
its differences in impact and whether it is consistent across different antenatal and
delivery-care services.
Methods: Using the 2013-2014 Zambia Demographic and Health Survey (ZDHS) data,
we specified multilevel models, to assess factors associated with (1) tetanus toxoid (TT)
inoculation (2) the choice of skilled birth attendants (3) choice of skilled provider during
antenatal care and (4) frequency of prenatal visits.
Results: The average prenatal visits for pregnant women was 3.8. Almost 83 percent of
women in the sample were immunized with tetanus toxoid, 93 percent had used some form
of formal antenatal care, and 73 percent had used formal delivery assistance for the most
recent child. At individual level, female education, partner’s education, household wealth,
birth history are positively associated with utilization of all health services whereas
household size is negatively associated. Women with secondary education had 2 times
and 16 percentage point’s greater log-odds of being assisted by a skilled provider than
women with no education for assisted deliveries and prenatal care respectively. There
exist differences in impacts of individual-level female education and community-level
education on maternal health-seeking behaviors with secondary level of education
consistently being more pronounced across all health services with an exception of TT
use. The proportion of educated women in the community, is positively associated with
TT use and showing expected positive association on the other three maternal health
services, though not significant. Community education had a 1.4 times greater log-odds
effect on TT use. At community level, region and place of residence are positively
associated with the use of all maternal health services. However, the results show that both
individual and community level factors have a much stronger effect in the rural sample.
Conclusion: The results suggest simultaneous targeting of health policy at both individual
and community-levels. Efforts by the government should be targeted to provide universal
secondary education in rural and hard-to-reach communities coupled with reducing
provincial and regional disparities in the provision of maternal health services.
Description
Master Arts in Economics
Keywords
Women's Health. , Women--Education