Integrating the Rights-based and Capability Approaches in the Analysis of Maternal Healthcare Utilization in sub-Saharan Africa: A Multilevel Modelling Study

Abstract

Background: The rights-based and capability approaches have received increased attention relative to maternal health in the aftermath of the 2015 Millenium Development Goals (MDGs). This is in view of the sub-optimal progress gained in reducing maternal and child mortality, especially in developing countries. Despite the combined potential of these models, limited empirical studies testing their viability in maternal health exist. This is what this study sought to accomplish. Method: We combined several datasets for this study, including the Demographic Health Survey (DHS), World Development Indicators, the World Governance Indicators and Freedom House. Using the R programming environment and the R2MLwiN package, Bayesian multilevel logistic regression models were applied on three indicators of maternal healthcare (antenatal care visits, institutional delivery, and postnatal check-ups) in relation to selected individual, community and country-level factors representing right-based and capability approaches. All the models report posterior odd ratios (POR).Results: The results support the potence of the rights-based and capability approaches in bolstering maternal healthcare utilization in sub-Saharan Africa. Living in countries which have high freedom status (POR = 1.19) and higher female secondary school enrolments (POR = 1.54) increases the odds of adequate antenatal care. Living in countries with high freedom status (POR =1.33) and higher voice and accountability (POR = 1.72) also increases the odds of institutional delivery. Similar results are reported for postnatal care where country freedom status (POR = 1.89), voice and accountability (POR = 1.25) and female school enrolment (POR = 1.41) are significant predictors. Conclusion: The results imply that the rights-based and capability approaches have the potential to enhance maternal healthcare utilization in sub-Saharan Africa. Therefore, policy strategies emphasizing on freedoms, accountability and individual capability functionings should be encouraged in the pursuit of achieving Sustainable Development Goals number 3.

Globalisation and Maternal Health Care Utilisation in sub-Saharan Africa: A Bayesian Multilevel Analysis

“…It is plausible that women who live in countries with high social globalisation index would be more likely to use maternal healthcare compared to their counterparts who do not. Several studies have demonstrated the crucial role played by exposure to the media as well as civil and socio-economic rights in maternal and reproductive health matters [33][34][35] . Promotion of civil, media, technology, and communication freedoms shape culture, enhance citizen awareness about their rights, and influence national politics which may in turn lead to better provision, access, and utilisation of health services.…”