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      Associations of antenatal care visit with utilization of institutional delivery care services in Afghanistan: intersections of education, wealth, and household decision-making autonomy

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          Abstract

          Background

          The importance of antenatal care (ANC) visits in safe motherhood and childbirth is well-documented. However, less is known how social determinants of health interact with ANC visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the associations of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant.

          Methods

          We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,590 women of reproductive age (15–49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot.

          Results

          Multivariable adjusted analyses suggest that women who had 4 or more ANC visits were 5.7 times (95% CI = 4.78, 7.11; P < 0.05) more likely to use delivery care at a health facility and 6.5 times (95% CI = 5.23, 8.03; P < 0.05) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions of ANC visits with education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status.

          Conclusion

          Our findings suggest that the associations of ANC visits with institutional delivery care services are stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12884-022-04588-0.

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          Most cited references35

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          Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity.

          Greta Bauer (2014)
          Intersectionality theory, developed to address the non-additivity of effects of sex/gender and race/ethnicity but extendable to other domains, allows for the potential to study health and disease at different intersections of identity, social position, processes of oppression or privilege, and policies or institutional practices. Intersectionality has the potential to enrich population health research through improved validity and greater attention to both heterogeneity of effects and causal processes producing health inequalities. Moreover, intersectional population health research may serve to both test and generate new theories. Nevertheless, its implementation within health research to date has been primarily through qualitative research. In this paper, challenges to incorporation of intersectionality into population health research are identified or expanded upon. These include: 1) confusion of quantitative terms used metaphorically in theoretical work with similar-sounding statistical methods; 2) the question of whether all intersectional positions are of equal value, or even of sufficient value for study; 3) distinguishing between intersecting identities, social positions, processes, and policies or other structural factors; 4) reflecting embodiment in how processes of oppression and privilege are measured and analysed; 5) understanding and utilizing appropriate scale for interactions in regression models; 6) structuring interaction or risk modification to best convey effects, and; 7) avoiding assumptions of equidistance or single level in the design of analyses. Addressing these challenges throughout the processes of conceptualizing and planning research and in conducting analyses has the potential to improve researchers' ability to more specifically document inequalities at varying intersectional positions, and to study the potential individual- and group-level causes that may drive these observed inequalities. A greater and more thoughtful incorporation of intersectionality can promote the creation of evidence that is directly useful in population-level interventions such as policy changes, or that is specific enough to be applicable within the social contexts of affected communities. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.
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            Multiple Jeopardy, Multiple Consciousness: The Context of a Black Feminist Ideology

            Deborah K. King (1988)
            Article 0 comments Cited 292 times – based on 0 reviews     Review now
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              Still too far to walk: Literature review of the determinants of delivery service use

              Sabine Gabrysch, Oona Campbell (2009)
              Background Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. Methods We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility. Results There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. Conclusion Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of delivery service use. The increasing availability of georeferenced data provides the opportunity to link health facility data with large-scale household data, enabling researchers to explore the influences of distance and service quality.
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                Author and article information

                Contributors
                Mostafizur Rahman:
                ORCID: https://orcid.org/0000-0001-9354-5613
                mostafiz@bsmraau.edu.bd
                Priom Saha:
                ORCID: https://orcid.org/0000-0002-0973-0128
                psaha@isrt.ac.bd
                Jalal Uddin:
                ORCID: https://orcid.org/0000-0002-8337-3480
                jalal.uddin@dal.ca
                Journal
                Journal ID (nlm-ta): BMC Pregnancy Childbirth
                Journal ID (iso-abbrev): BMC Pregnancy Childbirth
                Title: BMC Pregnancy and Childbirth
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2393
                Publication date (Electronic): 26 March 2022
                Publication date PMC-release: 26 March 2022
                Publication date Collection: 2022
                Volume: 22
                Electronic Location Identifier: 255
                Affiliations
                [1 ]Department of Science and Humanities, Bangabandhu Sheikh Mujibur Rahman Aviation and Aerospace University, Old Airport, Tejgaon, Dhaka, 1215 Bangladesh
                [2 ]GRID grid.8198.8, ISNI 0000 0001 1498 6059, Institute of Statistical Research and Training, , University of Dhaka, ; Dhaka, 1000 Bangladesh
                [3 ]GRID grid.55602.34, ISNI 0000 0004 1936 8200, Department of Community Health and Epidemiology, , Dalhousie University, ; Halifax, Nova Scotia Canada
                Author information
                https://orcid.org/0000-0001-9354-5613
                https://orcid.org/0000-0002-0973-0128
                https://orcid.org/0000-0002-8337-3480
                Article
                Publisher ID: 4588
                DOI: 10.1186/s12884-022-04588-0
                PMC ID: 8961925
                PubMed ID: 35346100
                SO-VID: 49462b34-4386-4ae8-88ed-e3c54a0211dc
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 6 December 2021
                Date accepted : 11 March 2022
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: maternal health,antenatal care (anc) visit,institutional delivery care service,delivery at a health facility,delivery assisted by a skilled birth attendant
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: maternal health, antenatal care (anc) visit, institutional delivery care service, delivery at a health facility, delivery assisted by a skilled birth attendant

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