Connecting the dots: An integrated framework for examining maternal health and health-seeking behavior

Background: About 500 women die each day of pregnancy-related complications in sub-Saharan Africa (SSA) and several others suffer various disabilities. Many of these deaths and disabilities can, however, be prevented with good quality maternal health services. Previous studies in SSA have demonstrated large socioeconomic disparities in use of maternal health services, but there is little empirical evidence on the factors underlying the disparities. This is likely because current models do not provide clear pathways for how distal factors like socioeconomic status affect maternal health and health-seeking behavior.

Aim: To propose an integrated framework for examining maternal health and health-seeking behavior that highlights pathways through which distal factors affect maternal health; and empirically test the assumptions of the framework.

Methods: Data are from the Ghana Maternal Health Survey (N=4,868). Analytic techniques include logistic regression with mediation and moderation analysis to examine intervening and conditional effects respectively.

Results: Three proximal factors directly affect use of maternal health services: perceived need, perceived accessibility (physical and economic) of maternal health services, and perceived quality of care (technical and interpersonal). These factors explain the socioeconomic disparities in use of maternal health services. Quality of care partially explains the differentials in pregnancy outcomes among women who use maternal health services.

Conclusion: Researchers need to examine the proximal factors because these are more amenable to change, hence more relevant for policy and programmatic purposes; they are also context specific, and so adequate knowledge of them in different contexts is essential to developing appropriate interventions.