Population Services International, 1120 19th Street, NW, Suite 600, Washington DC 20036, USA.
Int J Equity Health. 2011 Jul 30;10:31. doi: 10.1186/1475-9276-10-31.
There is expert consensus that delivery at a health facility substantially reduces the risk of maternal death. By increasing the use of antenatal (ANC), postnatal care (PNC) and family planning, the risk of maternal death can be further reduced. There has been little investigation of factors associated with the use of these services in Pakistan.
A representative household survey was conducted in rural areas of Jhang district, Pakistan, to determine the effect of demographic, economic and program factors on the utilization of maternal health services. Married women who had children ages 12 months or younger were interviewed. Data was collected from 2,018 women on socio-demographic characteristics and the utilization of health services. Logistic regression analysis was conducted to identify the correlates of health services use. Marginal effects quantify the impact of various factors on service utilization.
Parity and education had the largest impact on institutional delivery: women were substantially less likely to deliver at a health facility after their first birth; women with primary or higher education were much more likely to have an institutional delivery. Age, autonomy, household wealth, proximity to a health facility and exposure to mass media were also important drivers of institutional delivery. The use of family planning within a year of delivery was low, with parity, education and husband's approval being the strongest determinants of use.
The findings suggest that rural women are likely to respond to well-designed interventions that remove financial and physical barriers to accessing maternal health services and motivate women by emphasizing the benefits of these services. Interventions should specifically target women who have two or more living children, little formal education and are from the poorest households.
专家一致认为，在医疗机构分娩可大大降低产妇死亡的风险。通过增加产前（ANC）、产后护理（PNC）和计划生育的使用，可以进一步降低产妇死亡的风险。然而，针对巴基斯坦这些服务的使用情况与哪些因素相关，目前研究甚少。
在巴基斯坦詹哈地区的农村地区进行了一项具有代表性的家庭调查，以确定人口统计学、经济和项目因素对产妇保健服务利用的影响。调查采访了有 12 个月或以下孩子的已婚妇女。从 2018 名妇女那里收集了社会人口特征和卫生服务利用情况的数据。采用逻辑回归分析来确定卫生服务利用的相关因素。边际效应量化了各种因素对服务利用的影响。
经产次和教育对住院分娩有最大影响：女性在首次分娩后，到医疗机构分娩的可能性大幅降低；具有小学或更高学历的女性更有可能在医疗机构分娩。年龄、自主权、家庭财富、离医疗机构的远近以及大众媒体的接触也是住院分娩的重要驱动因素。分娩一年内计划生育的使用率较低，经产次、教育和丈夫的认可都是使用的最强决定因素。
研究结果表明，农村妇女可能会对精心设计的干预措施做出反应，这些措施可以消除获得产妇保健服务的经济和身体障碍，并通过强调这些服务的好处来激励妇女。干预措施应特别针对有两个或更多活产子女、受教育程度较低和来自最贫困家庭的妇女。
