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Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan

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Abstract

Introduction The Islamic Republic of Pakistan’s maternal mortality ratio is particularly high, and the nation ranks 126 out of 149 countries on the Human Development Report-Gender Inequality Index. This is because Pakistani women have low levels of empowerment, make limited economic contributions, and underutilization of maternal health care. The aim of this study is to create a multidimensional index of women’s empowerment and assess the association between this index and maternal health care utilization in Pakistan, controlling for individual characteristics and community-level traits. Methods Data from the 2012–2013 Pakistan Demographic and Health Surveys were employed to investigate the relationship between this index and the latent construct of maternal health care utilization. Results Using exploratory factor analysis, four indicators of maternal health care utilization were loaded onto a single latent factor. Multivariate analyses found support for the association between empowerment and health care utilization, despite adjustments for individual and area level factors. Positive associations between education, wealth, and maternal health care utilization were found. Conclusions Although we find support for the association of educational attainment with maternal health care utilization, the multidimensional women’s empowerment index was independently a consistent associate of maternal health care utilization. This illustrates a complex mechanism with both—education and empowerment, being necessary for improved maternal health care utilization. Policy makers seeking to improve outcomes should expand their focus beyond simply improving rates of education to examining effects of cultural norms which constrain the independence of women in making decisions about their own health care.

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Acknowledgements

The authors would like to thank the UAB Sparkman Center for Global Health for its ongoing support of scientific discovery in resource-constrained settings.

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Authors and Affiliations

  1. Department of Health Services Administration, University of Alabama at Birmingham, 563 School of Health Professions Building, 1705 University Boulevard, Birmingham, AL, 35294, USA

    Kristine R. Hearld & Jami L. Anderson

  2. Department of Health Care Organization and Policy, African American Studies, School of Public Health, University of Alabama at Birmingham, 310D Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294, USA

    Henna Budhwani

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  1. Kristine R. Hearld
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  2. Jami L. Anderson
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  3. Henna Budhwani
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Correspondence to Kristine R. Hearld.

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Hearld, K.R., Anderson, J.L. & Budhwani, H. Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan. Matern Child Health J 22, 1319–1326 (2018). https://doi.org/10.1007/s10995-018-2512-3

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  • DOI: https://doi.org/10.1007/s10995-018-2512-3

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