Structural violence and maternal healthcare utilisation in sub-Saharan Africa: A Bayesian multilevel analysis

HM Sociology

Simona, Simona Joseph ; Ferrie, Joanna

University:University of Glasgow

Department:School of Social and Political Sciences

关键词: Structural violence, maternal healthcare, gender relations, globalisation, models, Bayesian inference, sub-Saharan Africa.;   

Others  :  http://theses.gla.ac.uk/80281/1/2020SimonaPhD.pdf

来源: University of Glasgow

【 摘 要 】

Considerable advances have been made in medical sociology and other population health- related subject areas to understand structural sources of disparities in health outcomes. We know that structural factors are the ‘fundamental causes’ of disease and illness. However, few studies focusing on structural conditions have considered maternal healthcare especially in sub-Saharan Africa. There is a dearth of knowledge regarding the effects of wider structural factors on maternal healthcare utilisation. Specifically, it is not well-known as to which dimension of the social structure is strongly associated with maternal healthcare and what specific combinations of factors influence adequate use of maternal healthcare in sub- Saharan Africa. This study was conceived to fill this gap in literature. The study focuses on community and country-level inequalities in gender relations, human rights violations and globalisation as the three dimensions of structural violence that are consequential to maternal healthcare in sub-Saharan Africa. I also consider individual level maternal characteristics that are associated with maternal healthcare utilisation.The analysis pools data of 245,955 respondents from the most recent Demographic and Health Surveys (DHS) and several other international datasets. I apply separate three-level Bayesian multilevel models on women who have had births five years prior to the recent DHS, nested in 17,000 communities, which are nested in 35 sub-Saharan African countries. On each aspect of structural violence, I estimate four models predicting the odds of having four or more antenatal care visits, institutional delivery and postnatal care based on a set of individual, community and country-level variables.Overall, the results indicate that inequalities in gender relations and disrespect for human rights are negatively associated with adequate use of maternal healthcare in sub-Saharan Africa. The relationship between globalisation and maternal healthcare is conditional on the specific dimension of globalisation. In comparison with other dimensions of globalisation, social globalisation is the most significant predictor of adequate maternal healthcare. These results help to underscore the importance of contextual factors in understanding women’s utilisation of maternal healthcare in sub-Saharan Africa.