School of Public Health, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA, 94720, USA.
Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, 1212, Bangladesh.
BMC Pregnancy Childbirth. 2023 Jun 13;23(1):436. doi: 10.1186/s12884-023-05737-9.
In South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women initiate antenatal care early in pregnancy and continue to attend after their first visit. One critical barrier to antenatal care attendance may be that women do not have sufficient power in their relationships, households, or communities to attend antenatal care when they want to. The main goals of this paper were to 1) understand the potential effects of intervening on direct measures of women's empowerment-including household decision making, freedom of movement, and control over assets-on antenatal care attendance in a rural population of women in Bangladesh, and 2) examine whether differential associations exist across strata of socioeconomic status.
We analyzed data on 1609 mothers with children under 24 months old in rural Bangladesh and employed targeted maximum likelihood estimation with ensemble machine learning to estimate population average treatment effects.
Greater women's empowerment was associated with an increased number of antenatal care visits. Specifically, among women who attended at least one antenatal care visit, having high empowerment was associated with a greater probability of ≥ 4 antenatal care visits, both in comparison to low empowerment (15.2 pp, 95% CI: 6.0, 24.4) and medium empowerment (9.1 pp, 95% CI: 2.5, 15.7). The subscales of women's empowerment driving the associations were women's decision-making power and control over assets. We found that greater women's empowerment is associated with more antenatal care visits regardless of socioeconomic status.
Empowerment-based interventions, particularly those targeting women's involvement in household decisions and/or facilitating greater control over assets, may be a valuable strategy for increasing antenatal care attendance.
ClinicalTrials.gov Identifier: NCT04111016, Date First Registered: 01/10/2019.
在南亚，大约有一半的女性会在至少四次产前保健中接受熟练卫生人员的护理，这是世界卫生组织为获得最佳生育结果所建议的最低次数。更多的女性至少会接受一次产前护理，这表明一个关键的挑战是确保女性在怀孕早期开始接受产前护理，并在第一次就诊后继续接受护理。影响产前护理就诊率的一个关键障碍可能是，女性在家庭、家庭或社区中没有足够的权力，无法在她们想要的时候接受产前护理。本文的主要目标是 1）了解干预直接衡量女性赋权的措施——包括家庭决策、行动自由和对资产的控制——对孟加拉国农村地区女性产前护理就诊率的潜在影响，2）研究是否存在跨越社会经济地位阶层的差异关联。
我们分析了孟加拉国农村地区 1609 名 24 个月以下儿童的母亲的数据，并采用靶向最大似然估计与集成机器学习相结合的方法来估计人群平均治疗效果。
更高的女性赋权与更多的产前护理就诊次数有关。具体来说，在至少接受过一次产前护理就诊的女性中，与低赋权相比，高赋权与接受≥4 次产前护理就诊的可能性更大（15.2%，95%置信区间：6.0%，24.4%），与中赋权相比（9.1%，95%置信区间：2.5%，15.7%）。推动关联的女性赋权子量表是女性的决策权和对资产的控制权。我们发现，无论社会经济地位如何，更高的女性赋权与更多的产前护理就诊次数有关。
以赋权为基础的干预措施，特别是那些针对女性参与家庭决策和/或促进对资产更大控制的干预措施，可能是增加产前护理就诊率的一种有价值的策略。
临床试验.gov 标识符：NCT04111016，首次注册日期：2019 年 1 月 10 日。
