Chatata Amanda Grace, Chirwa Gowokani Chijere
Economics Department, University of Malawi, P.O. box 280, Zomba, Malawi.
Economics Department, Northwest University, Potchefstroom, South Africa.
Health Econ Rev. 2025 Jan 4;15(1):1. doi: 10.1186/s13561-024-00581-9.
Poverty remains a key barrier to accessing essential maternal health services, particularly in low- and middle-income countries like Malawi. Despite the recognised importance of antenatal care (ANC) in ensuring healthy pregnancies as well as improving maternal and child health outcomes, ANC services remain underutilised by many women living in poverty. This underutilisation is not solely driven by a lack of financial resources but also by a range of non-monetary factors that constitute multidimensional poverty, such as limited access to education, healthcare services, and infrastructure. While much of the existing literature focuses on monetary poverty, this study explores how multidimensional poverty impacts ANC utilisation. By examining how various deprivations intersect to limit access to ANC, this research contributes to understanding the broader issue of healthcare inequality.
We assess the impact of multidimensional poverty (non-monetary) on antenatal care use in Malawi.
Multidimensional poverty was constructed using the Forster-Akire method of the Oxford Poverty and Human Initiative (OPHI). We use data from the 2015-16 Demographic Health Survey (DHS), which includes information on women aged 15-49 who gave birth within five years of the survey. To mitigate selection bias, we use Propensity Score Matching (PSM) techniques for our principal analysis.
Our findings reveal that 52% of women adequately utilised ANC services. About 8,428 women were identified as multidimensionally poor, and 4,685 were classified as non-poor. The results of our PMS analysis show a significant negative relationship between ANC utilisation and multidimensional poverty (B = 0.52; P < 0.008), indicating that multidimensionally poor women are less likely to use ANC services. Similarly, the timing of ANC visits also showed a negative relationship with multidimensional poverty (B = 0.26; P < 0.04), highlighting that multidimensionally poor women are less likely to attend ANC visits within the recommended first trimester.
The findings suggest that there is a need for sustainable investments in poverty alleviation programs to address and reduce multidimensional poverty as well as raise awareness of sexual and reproductive health concerns among adolescents and women in Malawi to improve maternal health outcomes.
贫困仍然是获取基本孕产妇保健服务的关键障碍，在马拉维等低收入和中等收入国家尤其如此。尽管产前保健（ANC）在确保健康怀孕以及改善母婴健康结局方面的重要性已得到认可，但许多生活贫困的妇女仍未充分利用产前保健服务。这种未充分利用不仅是由于缺乏财政资源，还受到一系列构成多维贫困的非货币因素的影响，例如获得教育、医疗服务和基础设施的机会有限。虽然现有文献大多关注货币贫困，但本研究探讨多维贫困如何影响产前保健的利用。通过研究各种贫困因素如何相互交织以限制获得产前保健的机会，本研究有助于理解医疗保健不平等这一更广泛的问题。
我们评估多维贫困（非货币）对马拉维产前保健利用的影响。
使用牛津贫困与人类发展倡议（OPHI）的福斯特 - 阿基雷方法构建多维贫困指标。我们使用2015 - 16年人口与健康调查（DHS）的数据，其中包括在调查前五年内分娩的15 - 49岁女性的信息。为了减轻选择偏差，我们在主要分析中使用倾向得分匹配（PSM）技术。
我们的研究结果显示，52%的妇女充分利用了产前保健服务。约8428名妇女被确定为多维贫困，4685名被归类为非贫困。我们的倾向得分匹配分析结果显示，产前保健利用与多维贫困之间存在显著的负相关关系（B = 0.52；P < 0.008），这表明多维贫困妇女使用产前保健服务的可能性较小。同样，产前检查的时间也与多维贫困呈负相关关系（B = 0.26；P < 0.04），这突出表明多维贫困妇女在推荐的孕早期进行产前检查的可能性较小。
研究结果表明，需要对扶贫项目进行可持续投资，以解决和减少多维贫困，并提高马拉维青少年和妇女对性健康和生殖健康问题的认识，以改善孕产妇健康结局。
