Inequalities in utilization of maternal health services in Uganda.

摘要

Progress towards the 5th Millennium Development Goal for reduction of maternal mortality by 2015 has been very negligible. In fact, maternal morbidity and mortality rates remain exceedingly high in the world's poorest regions, particularly in sub-Saharan Africa. The use of maternal health services is considered one of the cornerstones of safe pregnancies and subsequent deliveries. Yet, women in sub-Saharan Africa still use maternal health services at low rates, therefore the need to examine the potential factors that influence the use of maternal health services for both antennal and delivery care among women of childbearing ages in sub-Saharan Africa. Most studies in sub-Saharan Africa have examined the effects of individual-level characteristics on the utilization of maternal health care services, largely failing to explore the effects of structural-level factors. The purpose of this dissertation was to: (1) examine the individual-level influences on both antenatal and delivery care in Uganda, a sub-Saharan African country; (2) explore the spatial variations of antenatal care use across different communities in Uganda, while examining the effects of availability and accessibility of health facilities relative to their use by Ugandan women; (3) examine the contextual influences on antennal and delivery care independently of the effects of individual-level characteristics. The Andersen Behavioral model was used to frame the hypotheses of this research. Results from the individual-level analyses show that demographic and socioeconomic variables are both important in explaining disparities in maternal health care use. Further, findings of the spatial analyses reveal that accessibility to health facilities is critical to their use by women of childbearing ages. Yet, while distance is important in antenatal care usage, spatial association adds little to the study of this outcome. Finally, results from the multilevel modeling analyses reveal the importance of contextual influences in explaining inequalities in maternal health care use.