Three essays on the economics of maternal health care

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Résumé (français)

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Résumé (anglais)

This thesis consists of three essays that address various aspects of the economics of maternal health care. The first two essays examine the determinants of utilization of maternal health care services in low-income countries, while the third essay examines the determinants of utilization of prenatal ultrasonography in Canada. The first essay examines the influence of prenatal attendance (as well as a wide array of observed individual-, household- and community-level characteristics) on a woman’s decision to give birth at a health facility or at home for thirty-two low-income countries (across Asia, Sub-Saharan Africa and Latin America). This empirical investigation employs the Demographic and Health Surveys (DHS) data and a two-level random intercept model. The results show that prenatal attendance has a substantial influence on the use of facility delivery in all three geographical regions. Women having four prenatal visits were 7.3 times more likely to deliver at a health facility than those with no prenatal care. The second essay addresses two related questions: what factors determine a woman’s decision to seek prenatal care; and are those the same factors that determine the frequency of care? This investigation also utilizes Demographic and Health Surveys (DHS) data for thirty-two low-income countries (across Asia, Sub-Saharan Africa and Latin America) and applies a two-part and multi-level model to that data. The results suggest that, though a wide range of factors influence both decisions, that influence varies in magnitude across the two decisions, as well as across the three geographical regions. The third essay examines the influence of various socioeconomic and demographic factors on the frequency of prenatal ultrasounds in Canada, while controlling for maternal risk profiles. This investigation utilizes data from the Maternity Experience Survey (MES) of the Canadian Perinatal Surveillance System and employs a count data regression model (the Poisson distribution) to estimate the effect of various factors on the number of prenatal ultrasounds. The results of this investigation suggest that, even after controlling for maternal risk factors, the type of health-care provider, province of prenatal care, and timings of first ultrasound are the strongest predictors of number of ultrasounds.