Data from: Paternal factors and inequity associated with access to maternal health care service utilization in Nepal: a community based cross-sectional study

Background: The threat of maternal mortality can be reduced by increasing use of maternal health services. Maternal death and access to maternal health care services are inequitable in low and middle income countries.The aim of this study is to assess associated paternal factors and degree of inequity in access to maternal health care service utilization. Methods: Analysis illustrates on a cross-sectional household survey that followed multistage-cluster sampling. Concentration curve and indices were calculated. Binary logistic regression analysis was executed to account paternal factors associated with the utilization of maternal health services. Path model with structural equation modeling (SEM) examined the predictors of antenatal care (ANC) and institutional delivery. Results: The finding of this study revealed that 39.9% and 45.5% of the respondents’ wives made ANC visits and utilized institutional delivery services respectively. Men with graduate and higher level of education were more likely (AOR: 5.91, 95% CI; 4.02, 8.70) to have ANC of their wives than men with no education or primary level of education. Men with higher household income (Q5) were more likely (1.99, 95% CI; 1.39, 2.86) to have ANC for their wives. Similarly, higher household income (Q5) also determined (2.74, 95% CI; 1.81, 4.15) for institutional delivery of their wives. Concentration curve and indices also favored rich than the poor. SEM revealed that ANC visit was directly associated to institutional delivery. Conclusions: Paternal factors like age, household wealth, number of children, ethnicity, education, knowledge of danger sign during pregnancy, and husband’s decision making for seeking maternal and child health care are crucial factors associated to maternal health service utilization. Higher ANC coverage predicts higher utilization of the institutional delivery. Wealthier population is more concentrated to maternal health services. The inequities between the poor and the rich are necessary to be addressed through effective policy and programs.

研究背景：提升孕产妇保健服务的使用率可降低孕产妇死亡风险。在中低收入国家，孕产妇死亡与孕产妇保健服务可及性均存在不公平性。本研究旨在评估与孕产妇保健服务利用相关的丈夫相关因素，以及服务可及性的不公平程度。
研究方法：本研究基于一项采用多阶段整群抽样的横断面家庭调查展开分析。研究计算了集中曲线与集中指数，开展二元logistic回归分析以探究与孕产妇保健服务利用相关的丈夫相关因素。同时采用结构方程模型（Structural Equation Modeling，SEM）构建路径模型，分析产前检查（Antenatal Care，ANC）与机构分娩的影响因素。
研究结果：本研究显示，受访男性的妻子中，分别有39.9%完成了产前检查、45.5%使用了机构分娩服务。与未接受教育或仅接受初等教育的男性相比，本科及以上学历男性的妻子完成产前检查的可能性更高（调整后优势比（Adjusted Odds Ratio，AOR）：5.91，95%置信区间（95% Confidence Interval，CI）：4.02~8.70）。家庭收入最高五分位组（Q5）的男性，其妻子完成产前检查的可能性更高（AOR：1.99，95% CI：1.39~2.86）。类似地，家庭收入最高五分位组（Q5）也与妻子的机构分娩服务利用显著相关（AOR：2.74，95% CI：1.81~4.15）。集中曲线与集中指数结果同样显示，孕产妇保健服务的利用偏向富裕人群。结构方程模型分析显示，产前检查与机构分娩存在直接关联。
研究结论：丈夫的年龄、家庭财富水平、子女数量、民族、受教育程度、孕期危险征兆知晓情况，以及丈夫在寻求妇幼保健服务时的决策话语权，均为影响孕产妇保健服务利用的关键相关因素。更高的产前检查覆盖率可预测更高的机构分娩服务使用率。富裕群体更集中地使用孕产妇保健服务。贫富群体间的服务利用不公平性，需通过有效的政策与项目加以解决。