https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/190 Thu, 20 Apr 2017 09:46:28 +0000 Bangladesh has one of the highest maternal mortality rates (MMR) in the world. The estimated lifetime risk of dying from pregnancy and childbirth related causes in Bangladesh is about 100 times higher compare to developed countries. However, utilization of maternal health care services (MHCS) is notably low. This study examines the socio-economic determinants of utilization of MHCS in some slum areas of Dhaka city. The overall utilization was 86.3% of women; however, utilization of different sorts of MHCS was very low, i.e., the mean utilization was found to be 2.25 out of 5 MHCS. Indicator wise, ANC, TT, institutional delivery, delivery assistance by health professional and PNC were received by 61.3%, 80.4%, 12.6%, 33.2% and 55.4% of women respectively. Variation was observed with different socio-economic variables. Multiple regression model could explain 38% of variance (P<0.001). Among the significant determinants, order of last birth negatively explained the most variance (15.2%). Similarly, distance between home and clinic was found to affect the utilization negatively. Besides, some respondents’ socio economic variables had a significant positive effect on MHCS utilization. To reduce maternal mortality in disadvantaged women in slum areas, this study might suggest a few pointers while considering formulation of policies and planning. Introduction Despite the presence of strategic and programmatic initiatives in order to reduce maternal and child health, maternal mortality and child mortality and morbidity continue to be high. Bangladesh has one of the highest maternal mortality rates (MMR) in the world, i.e. 3/1000 live births.5 The tragic consequence of these deaths is that about 75% of the babies born to these women also die within the first week of their lives. On the other hand, infant and child mortality are respectively 52 per 1000 live birth and 14 per 1000 children.6   The data used in this study were collected from three randomly selected slum dwelling women of reproductive age through a semi structured survey questionnaire which included the socioeconomic, demographic and cultural characteristics of respondents as well as the family, and utilization of maternal health care services in their last pregnancy. The slums were identified applying the cluster sampling technique. From the three slums, 540 women were successfully interviewed. Simple linear regression analysis was considered at multivariate level in order to identify the factors affecting the utilization of maternal health services. In this regard, the following equation was used to estimate the regression coefficients: Where, Y= dependent variable, a = constant, b = the regression coefficient, X = independent variables of the model, K= end number of the series, e = error term. Results Utilization of the number of services by the women in general was lower than expected. On average, women utilized 2.25 MHCS with standard deviation 1.46. Among 86.3% women who utilized MHCS, 21.1%, 17.8% and 29.4% of them utilized respectively 1, 2 and 3 MHCS while only 9.8% and 8.1% women respectively utilized 4 and 5 MCHS.         Correlates of Utilization of Maternal Health Care Services     Besides, the order of last birth had a significant negative association with utilization of MHCS. On average, women who had given only one birth utilized 2.92 MHCS which almost gradually decreased to around 1.72 among women who had given birth to more than 6 children. Almost similarly, distance form home to clinic and respondent’s age at last birth had significant association with utilization of MHCS suggesting that women whose households were far away from clinic and who were older were more likely to utilize MHCS less than those women whose household was nearer to the clinics and were at a younger age. Determinants of Utilization of MHCS The overall regression model explained 38.0% (Adjusted R Square) of variance with P<0.001 in utilization of MHCS (Table 3). The most explanatory variable was order of the last birth which alone explained 15.2% variance (P<0.001) indicating that women’s higher birth order of the last child were less likely to utilize MHCS in slum areas. With similar direction to order of last birth, distance between home and clinic and age at last birth respectively explained 3.0% and 0.6% of variance.   Over all, the level of the utilization of maternal health care services was no satisfactory in the slum areas. On average, women received 2.25 MHCS. Due to the greater confidence and experience of the older and higher parity women together with greater responsibilities within the household and for child care, these women were more likely to utilize maternal health care services.7 However, in this study, the findings were opposite. Similar findings were also found in other studies.8, 9,10 Women having a longer distance from home to clinic utilized less MHCS than women with shorter distance. This is similar to many other studies.19-26 This may be because poor road conditions and congested houses can make it extremely difficult for women to reach even relatively nearby facilities. In a study conducted in Tanzania, it was found that women who gave birth at home actually intended to deliver at a health facility but could not do so due to distance and lack of transportation.27 Mass media increases awareness about innovations, and fosters inter-personnel communication, which could facilitate behavioural changes allowing for the adoption of new/different behaviours.28-29 Consistently, mass media exposure had significant positive impact on maternal health care services utilization. Women with higher positive attitude towards maternal health care services were found to utilize MHCS more than that of women with negative attitude. This may be because positive attitude diverts them from traditional way of care seeking such as from traditional birth attendant and/or relatives. Women who gave birth at higher ages were found to utilize MHCS more compared to women with lower age at last birth. Most probably this was because the former group were more experienced on complications due to pregnancy and were more inclined to seek service from health professional. Conclusion   We acknowledge the financial support provided by United Nations Population Fund (UNFPA) for conducting this research. References 2.   The state of world population: United Nations Population Fund, New York, 1995. 4.   The Progress of Nations, UNICEF: New York, 1996. 6.   Bangladesh Demographic and Health Survey 2007. 8.   Elo TI. Utilization of maternal health-care services in Peru: the role of women’s education, Heal Trans Rev 1992; 2: 49–69. 10.Wong EL, Popkin BM, Gullkey DK, Akin JS. Accessibility, quality of care and prenatal care use in the Philippines, Soc Sci Med 1987; 24: 927-944. 12.Addai I. Demographic and socio-cultural factors influencing use of maternal health services in Ghana, African J Repro Heal 1998; 2: 73-80. 14.Fosu GB. Childhood morbidity and health services utilization: cross-national comparisons of user-related factors from DHS data, Soc Sci Med 1994; 38: 1209-1220. 16.Navaneetham K., Dharmalingam A. Utilization of maternal health care services in Southern India, Soc Sci Med 2002; 55: 1849-1869. 18.Rani M, Bonu S. Rural Indian women’s care seeking behavior and choice of provider for gynecological symptoms, Stud Fam Plann 2003; 34: 173-185. 20.Alix-Dancer P. Access to health care in developing countries. In: Developing countries, society and technology. Stockholm: Royal Institute of Technology (KTH), 2003. 22.Rahaman MM, Aziz KM, Munshi MH, Patwari Y, Rahman M.A diarrhoea clinic in rural Bangladesh: influence of distance, age and sex on attendance and diarrheal mortality, Am J Pub Heal 1982; 72: 1124-1128. 24.Abbas AA, Walkern GJA. Determinants of the utilization of maternal and child health services in Jordan, Int J Epidem 1986; 15: 404-407. 26.Paul BK. Health service resources as determinants of infant death in rural Bangladesh: an empirical study, Soc Sci Med 1991; 32: 43-49. 28.Ahmed SM, Adams AM, Chowdhury M, Bhuiya A. Gender, socioeconomic development and health seeking behavior in Bangladesh, Soc Sci Med 2000; 51: 361-371. 2026 Ibrahim Medical College. All rights reserved.