Maternal education level and maternal healthcare utilization in the Democratic Republic of the Congo: an analysis of the multiple indicator cluster survey 2017/18

Abstract

Background Understanding how socioeconomic factors influence maternal health services utilization is crucial to reducing preventable maternal deaths in the DRC. Maternal education is considered an important associate of maternal health service utilization. This study aims to investigate the association between maternal education and the utilization of maternal health services, as well as present geographical and socio-economic disparities in the utilization. Methods The MICS survey was employed as the data source, which is a nationally representative survey conducted from 2017 to 2018 in the DRC. The exposure for this study was the maternal education level, which was categorized into three groups: (1) below primary and none, (2) primary and (3) secondary and above. Prenatal care indicators included: if the mother ever received prenatal care, if the mother had antenatal checks no less than four times, and if a skilled attendant was present at birth. Postnatal care indicators included: if the mother received postnatal care and if the baby was checked after birth. Emergency obstetric interventions were indicted by cesarean sections. Descriptive analyses and logistic regressions were used as analytical methods. Results Of all 8,560 participants included, 21.88 % had below primary school or no education, 39.81 % had primary school education, and 38.31 % had secondary education or above. The majority of participants were from rural areas, except for Kinshasa. Overall, a better education was associated with higher utilization of antenatal care. A dose-response effect was also observed. Compared to women with below primary or no education, women with secondary and above education were more likely to receive cesarean sections. Wealth status, as well as rural and urban division, modified the associations. Conclusions Mothers’ education level is an important associate for utilizing appropriate maternal healthcare, with wealth and region as modifying factors. Educational levels should be considered when designing public health interventions and women’s empowerment programs in the DRC. For example, relevant programs need to stratify the interventions according to educational attainment.

Flat trend of high caesarean section rates in Peru: A pooled analysis of 3,376,062 births from the national birth registry, 2012 to 2020

“…This is consistent with previous evidence in other low- and middle-income settings. 26 , 27 , 28 , 29 Similarly, and also consistent with the available evidence, C-section rates were higher amongst mothers with access to private health insurance (including those who directly paid for the procedure). 30 , 31 , 32 , 33 We hypothesize that, mothers with higher socioeconomic status, better educated, private health insurance holders and those able to afford out-of-pocket health expenditures, may have the greater access to C-section services.…”

“…A previous study using the Peruvian Demographic and Family Health Surveys (ENDES, in Spanish) that C-section rates were 21.4% in 2009 and 34.5% in 2018%. 29 , 30 Although ENDES is a representative national survey, the use of secondary data from a survey might have resulted in reduced precision and accuracy of the estimated data at national and subnational levels. 29 , 30 Due to the implementation of some health policies and interventions at the regional level (first administrative division in Peru), a subnational characterization of C-section rates could provide detailed information to policymakers and local health authorities.…”

“… 29 , 30 Although ENDES is a representative national survey, the use of secondary data from a survey might have resulted in reduced precision and accuracy of the estimated data at national and subnational levels. 29 , 30 Due to the implementation of some health policies and interventions at the regional level (first administrative division in Peru), a subnational characterization of C-section rates could provide detailed information to policymakers and local health authorities. In terms of maternal and child health, Peru and other countries in Latin America show large within country inequalities.…”

Variation in maternal mortality in Sidama Regional State, southern Ethiopia: A population based cross sectional household survey

“…A multi-country study showed mothers with no education had 2.7 times higher risk of mortality than mothers with high education [55]. Educated women better utilize maternal health services [56, 57] and recognize pregnancy complications, prepare for births and obstetric emergencies [58].…”

Prevalence and factors associated with the awareness of obstetric fistula among women of reproductive age in The Gambia: a multilevel fixed effects analysis

“…In addition, older women are more likely to have attained higher education than younger women. Education increases women's access to and utilisation of healthcare information [ 31 – 33 ]. As a result, better-educated women tend to be more informed about their reproductive health than uneducated women.…”