Associations of antenatal care visit with utilization of institutional delivery care services in Afghanistan: intersections of education, wealth, and household decision-making autonomy

Abstract

Background The importance of antenatal care (ANC) visits in safe motherhood and childbirth is well-documented. However, less is known how social determinants of health interact with ANC visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the associations of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant. Methods We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,590 women of reproductive age (15–49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot. Results Multivariable adjusted analyses suggest that women who had 4 or more ANC visits were 5.7 times (95% CI = 4.78, 7.11; P < 0.05) more likely to use delivery care at a health facility and 6.5 times (95% CI = 5.23, 8.03; P < 0.05) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions of ANC visits with education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status. Conclusion Our findings suggest that the associations of ANC visits with institutional delivery care services are stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status.

Antenatal care utilization and its associated factors in Somalia: a cross-sectional study

“…We found ANC attendance likely to be associated with delivering in a health structure. Similar studies found that ANC visits are an essential and significant determinant of delivery at a health facility [ 33 , 34 ].…”

Development and evaluation of a culturally adapted digital-platform integrated multifaceted intervention to promote the utilization of maternal healthcare services: a single-arm pilot study

“…This multifaceted intervention successfully encouraged pregnant women’s timely initiation and completion of ANC, and was found to be effective in promoting hospital delivery. Previous research conducted in developing areas demonstrated that women who receive timely and adequate ANC were 2.4–6.8 times more likely to deliver at a healthcare facility compared to those who did not receive ANC [ 23 – 26 ]. During ANC visits, ANC providers offer advice based on maternal and fetal health, facilitating informed decisions regarding childbirth delivery.…”

Women’s knowledge of perceived severity of illness predicting healthcare seeking behaviour for antenatal, postnatal care, and institutional delivery services. Findings from a National Survey in Afghanistan

“…Several studies in Afghanistan have examined utilization of maternal healthcare and the associated in uential factors in recent years (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Of these, one study found that sociodemographic and cultural (woman's role in making the decision to seek PNC service) factors were associated with the utilization of PNC visits (12).…”

“…Of these, one study found that sociodemographic and cultural (woman's role in making the decision to seek PNC service) factors were associated with the utilization of PNC visits (12). Three studies reported that sociodemographic and cultural factors were associated with institutional deliveries or skilled birth attended deliveries (13,14,18). One of the three studies reported that women who had at least four ANC visits were more likely to give birth in a health facility or with skilled birth attendants than those who had none, and women from higher socioeconomic status used institutional deliveries more than women from lower socioeconomic status (13).…”

“…Three studies reported that sociodemographic and cultural factors were associated with institutional deliveries or skilled birth attended deliveries (13,14,18). One of the three studies reported that women who had at least four ANC visits were more likely to give birth in a health facility or with skilled birth attendants than those who had none, and women from higher socioeconomic status used institutional deliveries more than women from lower socioeconomic status (13). The second study revealed that a history of complications in previous births, the husband's education, and ANC visits were associated with institutional deliveries (14).…”