Faculty of Medicine, University of Burundi, Bujumbura, Burundi.
Institute for Global Health, University College London, London, UK.
BMC Pregnancy Childbirth. 2021 Oct 7;21(1):684. doi: 10.1186/s12884-021-04162-0.
Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distances to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite antenatal care (ANC), delivery and postnatal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four ANC visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.
We use data from the 2016-2017 Burundi Demographic and Health Survey (DHS) collected from 8941 women who reported a live birth in the five years that preceded the survey. We use multivariate regression analysis to explore which individual-, household-, and community-level factors determine the likelihood that women will seek ANC services from a trained health professional, the number of ANC visits they make, and the choice of assisted childbirth.
Occupation, marital status, and wealth increase the likelihood that women will seek ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than non-educated women and women not in union. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are to have assisted childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth.
In Burundi, utilisation of maternal health services is low and is mainly driven by legal union and wealth status. To improve equitable access to maternal health services for vulnerable population groups such as those with lower wealth status and unmarried women, the government should consider certain demand stimulating policy packages targeted at these groups.
孕期和分娩期间及时、适当的医疗保健是改善产妇健康结果的支柱。然而，贫困和教育水平低、距离医疗机构远以及医疗服务费用高可能会成为及时获得和利用产妇保健服务的障碍。尽管在布隆迪，产前护理（ANC）、分娩和产后护理都是免费的，但这些服务的利用率仍然很低：在 2011 年至 2017 年期间，只有 49%的孕妇至少接受了四次 ANC 检查。本研究探讨了影响布隆迪产妇保健服务利用的社会经济决定因素。
我们使用了 2016-2017 年布隆迪人口与健康调查（DHS）的数据，该数据来自 8941 名在调查前五年内报告过活产的妇女。我们使用多变量回归分析来探讨哪些个体、家庭和社区层面的因素决定了妇女寻求接受培训的卫生专业人员提供的 ANC 服务、接受 ANC 检查的次数以及选择辅助分娩的可能性。
职业、婚姻状况和财富增加了妇女寻求接受培训的卫生专业人员提供的 ANC 服务的可能性。已婚妇女和处于伴侣关系中的妇女咨询接受培训的卫生专业人员进行 ANC 服务的可能性分别是未婚妇女的 18 倍和 16 倍。受过教育的妇女和目前处于联盟或伴侣关系中的妇女比未受过教育的妇女和没有联盟的妇女接受更多的 ANC 检查。在更高的分娩顺序中，妇女往往不接受 ANC 检查。接受的 ANC 检查次数越多，妇女越富有，她们进行辅助分娩的可能性就越大。完成四次或更多 ANC 检查的妇女进行辅助分娩的可能性是没有完成的妇女的 14 倍。
在布隆迪，产妇保健服务的利用率很低，主要受合法联盟和财富状况的驱动。为了改善弱势群体（如财富状况较低和未婚妇女）公平获得产妇保健服务的机会，政府应考虑针对这些群体的某些需求刺激政策方案。
