Wealth Status, Health Insurance, and Maternal Health Care Utilization in Africa: Evidence from Gabon

Abstract

Background. To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low. The achievement of universal health care requires the provision and availability of an adequate financing system. This study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon. Methods. The study used the 6th round of Gabon Demographic and Health Surveys (GDHSs)—2012 data to explore three outcome measures of maternal health care utilization extracted on number of antenatal care (ANC) visits during pregnancy, place of birth delivery, and postnatal health care. The dependent variable was women with health insurance coverage against those without. Logistic regression and propensity scoring matching analysed associations of health insurance coverage on women’s utilization of health care. Results. Mean (+/− SD) age of women respondents of reproductive age was 29 years (9.9). The proportion of at least 4 antenatal care visits was 69.2%, facility-based delivery was 84.7%, and postnatal care utilization was 67.9%. The analysis of data showed disparities in maternal health care services utilization. The GDHS showed maternal age, and geographical region was significantly associated with maternal health care service utilization. A high proportion of urban dwellers and Christian women used maternal health care services. According to the wealth index, maternal health services utilization was higher in women from wealthy households compared to lower households wealth index (ANC (Conc. Index = 0.117; p≤0.001), facility-based delivery (Conc. Index = 0.069; p≤0.001), and postnatal care (Conc. Index = 0.075; p≤0.001), respectively). With regard to health care insurance coverage, women with health insurance were more likely to use ANC and facility-based delivery services than those without (concentration indices for ANC and facility-based delivery were statistically significant; ANC: z-stat = 2.69; p=0.007; Conc. Index: 0.125 vs. 0.096 and facility-based delivery: z-stat = 3.38; p=0.001; Conc. Index: 0.076 vs. 0.053, respectively). Conclusion. Women enrollment in health insurance and improved household’s financial status can improve key maternal health services utilization.

Correlates of antenatal care utilization among women of reproductive age in sub-Saharan Africa: evidence from multinomial analysis of demographic and health surveys (2010–2018) from 31 countries

“…Education promotes a better enlightenment on issues especially health-related ones and this gives women with secondary or higher education an advantage over their uneducated counterparts. Household wealth shows a significant relationship with antenatal care utilization as women from richest households have higher probability of utilizing antenatal care adequately than women from poorest households [20][21][22][23][24]. Poverty at household level may constitute a great barrier to accessing maternal health services.…”

Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries

“…Consequently, richest women have some leverage over poorest women. 37 Moreover, wealth is a pathway to empowerment 38 and it is well established in the literature that once a woman is empowered, it is more probable that she will use maternal healthcare. 39 40 A poor woman may know and acknowledge the essences to get her child immunised in full, but her passion may remain a mirage if the requisite financial capacity is non-existent.…”

Factors Related to Postnatal Care Utilization in Indonesia in 2018: An Ecological Study

“…Meanwhile, socioeconomic factors are also reported to affect postnatal visits to health workers. This is related to the ability to pay service fees 8 . Besides, the government must be able to guarantee the availability of midwives and gynecologists as the personnel who provide midwifery services.…”