Community influences on maternal health care seeking behavior in Bangladesh, Egypt and Rwanda

Previous studies of maternal health care behavior have focused on how the health care infrastructure impacts care seeking behavior during pregnancy, in the absence of the consideration of other contextual factors, such as prevailing community norm, structural factors and economic/ social opportunities. This study explores associations between community-level characteristics and the uptake of maternal care services in 3 resource-poor settings. Representative samples of women age 15 – 49 are taken from 3 Demographic and Health Surveys: Bangladesh (2007), Egypt (2008), and Rwanda (2005). The study identifies the contribution of individual, household and community-level variables in explaining differentials in maternal health care utilization. Multi-level models are fitted to identify the determinants of receiving any antenatal care, receiving at least four visits, and receiving the first care visit during the first trimester of pregnancy. The results show that community influences are significantly associated with the use of maternal health care services and persist after controlling for individual and household factors. These findings can be used to inform public health interventions to increase the use of maternal health care and inform health policy in other environments, particularly resource-poor settings.