Disparities in utilization of maternal health care services in Uganda
Early utilization of maternal health care services (antenatal care, facility based delivery and postnatal care) is associated with reduction of maternal mortality and morbidity. However, disparities in utilization of maternal healthcare services in Uganda still persist. This study aimed at investigating the interrelationships and regional differences in early utilization of key maternal healthcare services in Uganda. Data was drawn from the 2016 Uganda Demographic and Health Survey and considered women whose last child was born within five years preceding the survey. A generalized structural equation model was used to determine the interrelationships between early antenatal care (first visit within the first trimester), facility based delivery and early postnatal care (within 48 hours after delivery) using a sample of 10,152 women. Additionally, nonlinear Oaxaca-Blinder Multivariate Decomposition method was used to examine factors associated with regional differences in early utilization of these maternal health services. A sample of 1,521 women was selected from Eastern (n= 939) and Western (n=583) regions. Overall, early antenatal care utilization was a significant predictor of health facility delivery and early postnatal care. In other words, women who utilized early antenatal care had a 4% increased odds of health facility delivery and 10% increased odds of attending early postnatal care compared to women who had a delayed first antenatal care attendance. Being married, reporting that distance to a facility is not a problem and having had pregnancy complications indirectly influenced facility based delivery. Older women (35-49 years), those who completed primary education and those who reported that cost of service was not a barrier indirectly predicted early postnatal care. Results on regional differences revealed critical disparities between Eastern and Western regions. These disparities were mainly due to differences in maternal education, community health worker availability, wealth and exposure to media. Findings suggest that utilization of early antenatal care increases health facility delivery and early postnatal care which highlights the important role of early antenatal care attendance in utilizing other key maternal health services. Progress towards equitable maternal healthcare services should focus on strategies that guarantee even distribution of community health workers, broad dissemination of maternal healthcare information and girl-child education completion in all regions of Uganda.