Predictors of person-centered maternity care: the role of socioeconomic status, empowerment, and facility type.

BACKGROUND: Low use of maternal health services, as well as poor quality care, contribute to the high maternal mortality in sub-Saharan Africa (SSA). In particular, poor person-centered maternity care (PCMC), which captures user experience, contributes both directly to pregnancy outcomes and indirectly through decreased demand for services. While many studies have examined disparities in use of maternal health services, few have examined disparities in quality of care, and none to our knowledge has empirically examined disparities in PCMC in SSA. The aim of this study is to examine factors associated with PCMC, particularly the role of household wealth, personal empowerment, and type of facility. METHODS: Data are from a survey conducted in western Kenya in 2016, with women aged 15 to 49 years who delivered in the 9 weeks preceding the survey (N = 877). PCMC is operationalized as a summative score based on responses to 30 items in the PCMC scale capturing dignity and respect, communication and autonomy, and supportive care. RESULTS: We find that net of other factors; wealthier, employed, literate, and married women report higher PCMC than poorer, unemployed, illiterate, and unmarried women respectively. Also, women who have experienced domestic violence report lower PCMC than those who have never experienced domestic violence. In addition, women who delivered in health centers and private facilities reported higher PCMC than those who delivered in public hospitals. The effect of employment and facility type is conditional on wealth, and is strongest for the poorest women. Poor women who are unemployed and poor women who deliver in higher-level facilities receive the lowest quality PCMC. CONCLUSIONS: The findings imply the most disadvantaged women receive the lowest quality PCMC, especially when they seek care in higher-level facilities. Interventions to reduce disparities in PCMC are essential to improve maternal outcomes among disadvantaged groups.

Birth intervals, postponement, and fertility decline in Africa: a new type of transition?

We investigated birth-interval dynamics in 24 African countries using data from 76 Demographic and Health Surveys conducted since 1986. Controlling for selection bias in the birth-history data using the Brass-Juárez method and regression models produced almost identical results. Birth intervals have lengthened in every country examined. This analysis uncovered a distinctive and previously undocumented pattern of childbearing that is prevalent across sub-Saharan Africa. After allowing for time trends in birth-interval length, the lengthening of birth intervals in almost every country varies little by women's age or parity. Moreover, in several countries, birth intervals are now too long to be explicable by birth spacing contingent on the age of women's youngest child. Rather, women are postponing births for other reasons. These findings offer empirical support for the idea that the fertility transition in sub-Saharan Africa is following a different pattern from that observed elsewhere.