Study: “Maternal and Child Health Outcomes in Zambia: Investigating Poverty, Equity and Demand Effects”
PI: Chitalu, Chama Miriam
Affiliation: University of Pretoria
Funding Partner: IIE
Method(s): Multilevel Logistic
Geographic Location: Zambia
Despite country-level programs and international goals which aimed to improve maternal health, indicators of maternal health in Zambia continue to show poor maternal and child health. There is a need to understand critical factors in improving maternal health. This study investigates how changes in poverty affect maternal and child health in Zambia, especially when analyzing the effects of equity in the utilization of health services. It focuses on two specific aspects of maternal health care: antenatal care (ANC) and facility-based deliveries, and answers two broad questions: What factors determine the use of ANC in Zambia? To what extent has the removal of user fees affected facility-based deliveries?
Results show that, while there are differences in the factors explaining the decision to use ANC and the frequency of visits over time, the decision to seek ANC and the frequency of use is low among poor and less-educated women, with marked regional differences in utilization. Findings also show that user fee removal immediately increases aggregate facility-based deliveries, although this did not affect the national trend. Drug availability and presence of traditional birth attendances also influence facility-based deliveries at the national level that strengthening and improving community-based interventions could increase facility-based deliveries in the short-term. User fee removals also had little, if any, impact on the choice of location for childbirth. These results highlight the importance of service quality in promoting facility-based deliveries, and also suggest that social and cultural factors, especially in rural areas, influence the use of health facilities for delivery. Removal of user fees have unintended consequences, possibly transferring facility costs to the patient. Therefore, abolishing user fees alone may not be sufficient to affect changes in maternal and child health, and addressing and improving service quality could have greater impact, which has important policy implications in the future.
Chama-Chiliba, Chitalu Miriam. (2014). An Economic analysis of maternal health care in Zambia(Doctoral Dissertation). University of Pretoria, Pretoria, South Africa.