Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada.
School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada.
BMC Public Health. 2021 Apr 30;21(1):830. doi: 10.1186/s12889-021-10884-9.
The republic of Benin ranks in the bottom third of countries recently assessed for ANC coverage and its Ministry of Family and National Solidarity (2009) reported close to 70% of Beninese women suffered abuse at least once in their lifetime. Utilization of antenatal care (ANC) services is key to positive health outcomes for both mother and infant. This study examined the impact of intimate partner violence (IPV) on the utilization of ANC services in Benin using both the basic 4 visit model (ANC-4) and the updated WHO recommended 8-visit model (ANC-8).
Data used for this study were collected from the nationally representative 2017-2018 Benin Demographic Health Survey (BDHS) on ever-partnered women aged 15-49 who had completed both reproductive maternal health and domestic violence modules of the survey. Descriptive statistics and multivariate logistic regression analysis were performed to determine significant factors associated with ANC utilization in Benin.
Over 40% of the women (n = 3084) reported experience of IPV in their lifetime. Findings revealed that women who ever experienced IPV (OR 0.753, 95% CI: 0.628-0.901; p = 0.002) had 25% less odds of accessing the basic four ANC visits. IPV was not found to be a factor in accessing at least eight ANC visits. With increasing number of children, there was less likelihood of accessing at least four and at least eight visits. Being in the richest quintile (OR 5.490, 95% CI 3.907-7.714; p < 0.000 for ANC-4; OR, 5.781, 95% CI: 3.208-10.41; p < 0.000), making decisions on household and health care (OR 1.279, 95% CI: 1.042-1.569 for ANC-4; OR, 1.724; 95% CI: 1.170-2.540; p = 0.006 for ANC-8), and getting paid cash for work increased the chances of utilizing ANC-four (OR 1.451, 95% CI: 1.122-1.876; 0.005) but not for ANC-eight. Belonging to the Muslim faith decreased the odds of ANC utilization compared to all other religions.
This work revealed key areas for maternal health policy makers and service providers in Benin to appropriately plan effective policies (i.e., alleviate poverty; equitable health services access; cultural sensitivity) and necessary interventions (i.e. ANC education, IPV prevention, paid employment, alcohol cessation) to increase utilization of ANC.
贝宁共和国在最近评估的国家中，其 ANC 覆盖率排在倒数三分之一，其家庭和民族团结部（2009 年）报告称，近 70%的贝宁妇女在其一生中至少遭受过一次虐待。利用产前护理（ANC）服务是母婴健康的关键。本研究利用基本的 4 次就诊模型（ANC-4）和更新的世界卫生组织推荐的 8 次就诊模型（ANC-8），考察了亲密伴侣暴力（IPV）对贝宁 ANC 服务利用的影响。
本研究使用的数据来自于全国代表性的 2017-2018 年贝宁人口与健康调查（BDHS），该调查涵盖了 15-49 岁曾与伴侣发生过性关系的妇女，她们完成了调查中关于生殖孕产妇健康和家庭暴力的模块。进行了描述性统计和多变量逻辑回归分析，以确定与贝宁 ANC 利用相关的显著因素。
超过 40%的妇女（n=3084）报告称在其一生中经历过 IPV。研究结果表明，曾经历过 IPV 的妇女（OR 0.753，95%CI：0.628-0.901；p=0.002）获得基本 4 次 ANC 就诊的机会减少了 25%。没有发现 IPV 是获得至少 8 次 ANC 就诊的因素。随着孩子数量的增加，获得至少 4 次和至少 8 次就诊的可能性降低。在最富有五分位数（OR 5.490，95%CI 3.907-7.714；p<0.000 用于 ANC-4；OR，5.781，95%CI：3.208-10.41；p<0.000）、做出家庭和医疗保健决策（OR 1.279，95%CI 1.042-1.569 用于 ANC-4；OR，1.724；95%CI：1.170-2.540；p=0.006 用于 ANC-8）以及因工作获得现金报酬，都增加了利用 ANC-4 的机会（OR 1.451，95%CI：1.122-1.876；0.005），但不是 ANC-8。与所有其他宗教相比，属于穆斯林信仰的人获得 ANC 服务的几率降低。
这项工作揭示了贝宁产妇健康政策制定者和服务提供者的关键领域，以便他们能够适当规划有效的政策（即减轻贫困；公平获得卫生服务；文化敏感性）和必要的干预措施（即 ANC 教育、预防 IPV、带薪就业、戒酒），以提高 ANC 的利用率。
