Maternal Healthcare Utilization Patterns

There are two dependent variables both defined as three-category ordered variables: timing of first ANC visit and type of delivery assistance, derived from the following questions: "How many months pregnant were you when you first received antenatal care for this pregnancy?" and "Who assisted with the delivery of (NAME OF CHILD)?" The World Health Organization (WHO) recommends that for the majority of normal pregnancies, ANC should consist of at least four visits during the course of the pregnancy, the first of which should occur within the first trimester [28 (link)]. Timing of first ANC visit was thus recoded as "None" for those who did not receive ANC at all; "Late" when the visit took place during the second or third trimester, and "Early" when it occurred during the first trimester. Type of delivery assistance was recoded into three categories: "None" for no assistance, assistance from relatives or others without professional skills; "TBA" for assistance from traditional birth attendants (TBA); and "Skilled professional" for assistance from either a doctor or a nurse/midwife.
Based on previous studies on the use of maternal services, the independent variables used in this study include education (coded as none, primary and secondary/higher); household wealth; urban-rural residence; and ethnicity [9 (link),25 (link),29 (link)-32 (link)]. Since DHS do not collect data on income or expenditures, the economic status of household is proxied by a household wealth variable constructed from household possessions and amenities and dwelling characteristics, using principal component analysis [33 ]. For the purpose of this study, the resulting continuous variable (wealth index) was recoded as tertiles with categories labelled poor, middle and rich. Other control variables are parity, age at birth of the child and marital status.