Influence of family members on utilization of maternal health care services among teen and adult pregnant women in Kathmandu, Nepal: a cross sectional study

Reproductive Health

Neelam Pradhan³  Amir Babu Shrestha¹  Tippawan Liabsuetrakul²  Priti Upadhyay² 

[1] Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal;Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand, 90110;Department of Obstetrics and Gynecology, Tribhuban University Teaching Hospital, Maharajgunj, Kathmandu, Nepal

关键词: Adults;    Teens;    Delivery;    Antenatal care;    Maternal health care services;    Utilization;    Mother-in-law;    Husband;    Family members;    Influence;   

Others  :  1131951
DOI  :  10.1186/1742-4755-11-92

 received in 2014-07-29, accepted in 2014-12-18,  发布年份 2014

【 摘 要 】

Background

In some developing countries a woman’s decision to utilize maternal health care services is not made by the woman herself but by other family members. The perception of family members regarding who is the most influential person for making the decision to utilize these services is inconclusive. Hence, this study aimed to determine the perceived influential person on utilization of antenatal care (ANC) and delivery care services among teen, young adult and adult pregnant women from the perspective of the woman themselves, their husband and their mother-in-law, identify the factors associated with the woman being the most influential person, and assess the level of agreement between the woman’s and her husband’s response to the woman being the most influential person.

Methods

A cross-sectional study was conducted at Paropakar Maternity and Women’s Hospital and Tribhuvan University Teaching Hospital. Purposive sampling technique was used to select 315 women of which 105 were from each age group and their accompanied husbands (n = 315) and mothers-in-law (n = 315). The proportion of perceived influential person and mean priority score of the perceived influence with its 95% confidence interval was calculated. The factors associated with the woman perceived as the most influential person were analyzed by multivariate logistic regression model. The agreement was analyzed using kappa statistic.

Results

Among teens and young adults and their husband and mother-in-law, the woman’s husband was perceived as the most influential person. Among adults, the most influential person for ANC was the woman herself but for delivery care was the woman’s husband. A woman of adult age, having a non-indigenous ethnicity or who was not referred was more likely to perceive herself as the most influential person in the decision to utilize delivery care. A fair to poor level of agreement was found on the perception of the most influential person for ANC and delivery care utilization.

Conclusions

Both women and their husbands influenced the decision to utilize ANC and delivery care but husbands were more influential, especially in teens and young adults. Thus, husband’s involvement is crucial as a strategy to improve maternal health care utilization in Nepal.

【 授权许可】

   
2014 Upadhyay et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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【 参考文献 】

• [1]WHO, UNICEF, UNFPA: Trends in maternal mortality 1990-2010. Geneva, Switzerland: WHO, UNICEF, UNFPA and The World Bank estimates; 2012. Available from: [http://www.searo.who.int/maldives/documents/Trends_in_maternal_mortality_A4__1990-2010.pdf webcite] [cited 2014 January 01]
• [2]WHO: Pregnant Adolescents, Delivering on global promises for hope. Geneva, Switzerland: World Health Organization; 2006. Available from: [http://whqlibdoc.who.int/publications/2006/9241593784_eng.pdf?ua=1 webcite] [cited 2014 January 10]
• [3]WHO: Adolescent pregnancy – Unmet needs and undone deeds. A review of the literature and programmes. Geneva, Switzerland: Issues in Adolescent Health and Development; 2007. Available from: [http://whqlibdoc.who.int/publications/2007/9789241595650_eng.pdf webcite] [cited 2014 January 5]
• [4]WHO: Antenatal care in developing countries: promises, achievements and missed opportunities. An analysis of trends, levels and differentials, 1990-2001. Geneva, Switzerland: World Health Organization; 2003. Available from: [http://www.childinfo.org/files/antenatal_care.pdf webcite] [cited 2014 January 5]
• [5]Robinson JJ, Wharrad H: The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations’ data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy. J Adv Nurs 2001, 34:445-455.
• [6]Atuyambe L, Mirembe F, Tumwesigye NM, Annika J, Kirumira EK, Faxelid E: Adolescent and adult first time mothers’ health seeking practices during pregnancy and early motherhood in Wakiso district, central Uganda. Reprod Health 2008, 5:13. BioMed Central Full Text
• [7]Rahman MM, Haque SE, Zahan MS: Factors affecting the utilisation of postpartum care among young mothers in Bangladesh. Health Soc Care Commun 2011, 19:138-147.
• [8]Adhikari R: Early marriage and childbearing: risks and consequences. Geneva, Switzerland: World Health Organization; 2003. Available from: [http://whqlibdoc.who.int/publications/2006/9241593776_eng.pdf webcite] [cited 2014 January 12]
• [9]Kingston D, Heaman M, Fell D, Chalmers B: Comparison of adolescent, young adult, and adult women’s maternity experiences and practices. Pediatrics 2012, 129:e1228-e1237.
• [10]Edirne T, Can M, Kolusari A, Yildizhan R, Adali E, Akdag B: Trends, characteristics, and outcomes of adolescent pregnancy in eastern Turkey. Int J Gynaecol Obstet 2010, 110:105-108.
• [11]Ministry of Health and Population, New ERA, ICF International: Nepal Demographic and Health Survey 2011. Calverton, Maryland, USA: Ministry of Health and Population, New ERA, ICF International; 2012.
• [12]Gross K, Alba S, Glass TR, Schellenberg JA, Obrist B: Timing of antenatal care for adolescent and adult pregnant women in south-eastern Tanzania. BMC Pregnancy Childbirth 2012, 12:16. BioMed Central Full Text
• [13]Finlayson K, Downe S: Why do women not use antenatal services in low- and middle-income countries? A meta-synthesis of qualitative studies. PLoS Med 2013, 10:e1001373.
• [14]United Nations: The Millennium Development Goals Report 2013. New York, USA: United Nations; 2013. Available from: [http://www.un.org/millenniumgoals/pdf/report-2013/mdg-report-2013-english.pdf webcite] [cited 2014 May 17]
• [15]Witter S, Khadka S, Nath H, Tiwari S: The national free delivery policy in Nepal: early evidence of its effects on health facilities. Health Policy Plan 2011, 26(Suppl 2):ii84-ii91.
• [16]Powell-Jackson T, Neupane BD, Tiwari S, Tumbahangphe K, Manandhar D, Costello AM: The impact of Nepal’s national incentive programme to promote safe delivery in the district of Makwanpur. Adv Health Econ Health Serv Res 2009, 21:221-249.
• [17]Government of Nepal, United Nations Country Team of Nepal: Nepal Millennium Development Goals Progress Report 2013. Kathmandu, Nepal: Government of Nepal, United Nations Country Team of Nepal; 2013. Available from: [http://planipolis.iiep.unesco.org/upload/Nepal/Nepal_MDG_2013.pdf webcite] [cited 2014 March 28]
• [18]Kaphle S, Hancock H, Newman LA: Childbirth traditions and cultural perceptions of safety in Nepal: critical spaces to ensure the survival of mothers and newborns in remote mountain villages. Midwifery 2013, 29(10):1173-1181.
• [19]Brunson J: Confronting maternal mortality, controlling birth in Nepal: the gendered politics of receiving biomedical care at birth. Soc Sci Med 2010, 71(10):1719-1727.
• [20]Teferra AS, Alemu FM, Woldeyohannes SM: Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, North West of Ethiopia: a community-based cross sectional study. BMC Pregnancy Childbirth 2012, 12:74. BioMed Central Full Text
• [21]Doku D, Neupane S, Doku PN: Factors associated with reproductive health care utilization among Ghanaian women. BMC Int Health Hum Rights 2012, 12:29. BioMed Central Full Text
• [22]Mumbare SS, Rege R: Antenatal care services utilization, delivery practices and factors affecting them in tribal area of north maharashtra. Indian J Community Med 2011, 36:287-290.
• [23]Simkhada B, Teijlingen ER, Porter M, Simkhada P: Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs 2008, 61:244-260.
• [24]Simkhada B, Porter MA, van Teijlingen ER: The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study. BMC Pregnancy Childbirth 2010, 10:34. BioMed Central Full Text
• [25]Some DT, Sombie I, Meda N: How decision for seeking maternal care is made–a qualitative study in two rural medical districts of Burkina Faso. Reprod Health 2013, 10:8. BioMed Central Full Text
• [26]Story WT, Burgard SA, Lori JR, Taleb F, Ali NA, Hoque DM: Husbands’ involvement in delivery care utilization in rural Bangladesh: a qualitative study. BMC Pregnancy Childbirth 2012, 12:28. BioMed Central Full Text
• [27]Liabsuetrakul T, Oumudee N: Effect of health insurance on delivery care utilization and perceived delays and barriers among southern Thai women. BMC Public Health 2011, 11:510. BioMed Central Full Text
• [28]van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH, Adazu K, Slutsker L, Lindblade KA: Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reprod Health 2006, 3:2. BioMed Central Full Text
• [29]Sabeena Jalal NAS: Ante Nata Care (ANC) seeking behavior among women living in an urban squatter settlement: results from an ethnographic study. Italian J Public Health 2011, 8(3):261-267.
• [30]Acharya DR, Bell JS, Simkhada P, van Teijlingen ER, Regmi PR: Women’s autonomy in household decision-making: a demographic study in Nepal. Reprod Health 2010, 7:15. BioMed Central Full Text
• [31]Senarath U, Gunawardena NS: Women’s autonomy in decision making for health care in South Asia. Asia Pac J Public Health 2009, 21(2):137-143.
• [32]Sim J, Wright CC: The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther 2005, 85:257-268.
• [33]Pembe AB, Urassa DP, Darj E, Carlsted A, Olsson P: Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice. Afr J Reprod Health 2008, 12:120-131.
• [34]White DDM, Rubardt M, Sissoko K, Stephenson R: The influence of intrafamilial power on maternal health care in Mali: perspectives of women, men and mothers-in-law. Int Perspect Sex Reprod Health 2013, 39:58-68.
• [35]UNDP in ThailandAvailable from: [http://www.th.undp.org/content/thailand/en/home/mdgoverview/overview/mdg3/ webcite] [cited 2014 March 12]
• [36]Thailand: health care for all, at a price. Available from: [http://www.who.int/bulletin/volumes/88/2/10-010210/en/ webcite] [cited 2014 March 12]
• [37]Thapa DK, Niehof A: Women’s autonomy and husbands’ involvement in maternal health care in Nepal. Soc Sci Med 2013, 93:1-10.
• [38]Pregnancy and Childbirth in Nepal. Available from: [http://www.nsmp.org/pregnancy_childbirth_nepal/ webcite] [cited 2014 March 4]
• [39]WHO: Adolescents, social support and help-seeking behavior. Geneva, Switzerland: World Health Organization; 2007. Available from: [http://whqlibdoc.who.int/publications/2007/9789241595711_eng.pdf?ua=1 webcite] [cited2014 May 25]
• [40]Tuladhar S, Khanal KRKCL, Ghimire PK, Onta K: Women’s Empowerment and Spousal Violence in Relation to Health Outcomes in Nepal: Further analysis of the 2011 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Nepal Ministry of Health and Population, New ERA, and ICF International; 2013. Available from: URL: http://dhsprogram.com/pubs/pdf/FA77/FA77.pdf webcite [cited 2014 May 28]
• [41]Arsenault C, Fournier P, Philibert A, Sissoko K, Coulibaly A, Tourigny C, Traore M, Dumont A: Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households. Bull World Health Organ 2013, 91(3):207-216.
• [42]Kulczycki A: Husband-wife agreement, power relations and contraceptive use in Turkey. Int Fam Plan Perspect 2008, 34:127-137.
• [43]Mullany BC: Spousal agreement on maternal health practices in Kathmandu, Nepal. J Biosoc Sci 2010, 42:689-693.