Queen's University, School of Kinesiology & Health Studies, PEC Rm. 223, Kingston, Ontario, Canada.
Soc Sci Med. 2010 Dec;71(11):1958-63. doi: 10.1016/j.socscimed.2010.09.007. Epub 2010 Sep 29.
The United Nations Millennium Development Goals have identified improving women's access to maternal health care as a key target in reducing maternal mortality in sub-Saharan Africa (sSA). Although individual factors such as income and urban residence can affect maternal health care use, little is known about national-level factors associated with use. Yet, such knowledge may highlight the importance of global and national policies in improving use. This study examines the importance of national female literacy on women's maternal health care use in continental sSA. Data that come from the 2002-2003 World Health Survey. Multilevel logistic regression was used to examine the association between national female literacy and individual's non-use of maternal health care, while adjusting for individual-level factors and national economic development. Analyses also assessed effect modification of the association between income and non-use by female literacy. Effect modification was evaluated with the likelihood ratio test (G(2)). We found that within countries, individual age, education, urban residence and household income were associated with lack of maternal health care. National female literacy modified the association of household income with lack of maternal health care use. The strength of the association between income and lack of maternal health care was weaker in countries with higher female literacy. We conclude therefore that higher national levels of female literacy may reduce income-related inequalities in use through a range of possible mechanisms, including women's increased labour participation and higher status in society. National policies that are able to address female literacy and women's status in sub-Saharan Africa may help reduce income-related inequalities in maternal health care use.
联合国千年发展目标确定，改善妇女获得产妇保健的机会是降低撒哈拉以南非洲（ssa）孕产妇死亡率的一个关键目标。尽管收入和城市居住等个人因素会影响产妇保健的使用，但对于与使用相关的国家一级因素知之甚少。然而，这种知识可能突出了全球和国家政策在改善使用方面的重要性。本研究探讨了国家女性识字率对ssa 大陆妇女产妇保健使用的重要性。数据来自 2002-2003 年世界卫生调查。采用多水平逻辑回归分析方法，在调整个人层面因素和国家经济发展的基础上，检验了国家女性识字率与个人不使用产妇保健之间的关系。分析还评估了女性识字率对收入与不使用之间关联的调节作用。用似然比检验（G(2)）评估调节作用。我们发现，在国家内部，个人年龄、教育、城市居住和家庭收入与缺乏产妇保健有关。国家女性识字率改变了家庭收入与缺乏产妇保健使用之间的关联。在女性识字率较高的国家，收入与缺乏产妇保健之间的关联强度较弱。因此，我们得出结论，较高的国家女性识字率可能通过一系列可能的机制，包括妇女劳动力参与率的提高和社会地位的提高，减少与收入相关的使用不平等。能够解决撒哈拉以南非洲女性识字率和妇女地位问题的国家政策，可能有助于减少与收入相关的产妇保健使用不平等。
