Healthy Mothers, Healthy Children:

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• Healthy Mothers, Healthy Children
• Does Maternal Demand for Antenatal Care Matter
  for Child Health in Nepal?
• Nafisa Halim
• Alok K. Bohara
• Xiaomin Ruan
• University of New Mexico

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Introduction

• High maternal mortality and chronic child
  malnutrition despite impressive child mortality
  reduction in Nepal
• High maternal mortality rate (540/100,000 live
  births in 1996)
• 1 in every 2 children, lighter for age and
  height 1 in every 10 children, shorter for age

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Context

• 5.3 of GNP in health expenditures
• Safe Motherhood Program in Nepal
• GO-NGO Collaboration in health
• Still, 80 of deliveries take place at home

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Research Questions

• (1) Why isnt antenatal care universal in Nepal?
• (2) Does antenatal care matter for child health?

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Prior Literature

• Maternal Education
• Learning about secular organizations
• Empowered and autonomous to go beyond tradition
• Paternal education is NOT as important

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Problems with Prior Studies Context-Insensitive?

• Patriarchal social and economic institutions
• Traditional pregnancy governing institutions
  favor mother-in-laws
• Pregnancy is shameful
• Event of childbirth polluted

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Problems with Prior Studies Methodological
Constraints

• Maternal education correlated with parental and
• spousal education
• Maternal education A correlation or a cause of
• antenatal care?
• Husbands role in pregnancy-related decision
  making
• His education helps to approve of maternal care
• utilization

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• Hypotheses
• H 1. Educated mothers are more likely to use
  professional antenatal care than their
  non-educated counterparts.
• H 2. Mothers are more likely to use maternal care
  if their husbands are educated.
• H 3. Mothers who have access to the media and,
  presumably, health-related information are more
  likely to use professional antenatal care than
  mothers who lack such access.
• H 4. Educated mothers tend to visit professional
  Antenatal care providers more frequently than
  their less-educated counterparts.
• H 5. Mothers will tend to visit professional
  antenatal care providers more frequently if their
  husbands are educated.
• H 6. Mothers who have access to the media and,
  presumably, health-related information tend to
  visit professional antenatal care providers more
  frequently than those who lack such access.
• H 7. Children whose mothers have sought routine
  professional antenatal care during pregnancy are
  healthier in their infant and toddler years than
  the children of mothers who have not sought such
  care.

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Data

• The Nepal Family and Health Survey (NFHS), 1996
  and 2001
• A stratified cluster-sampling design
• A nationally representative sample of 8,429
  women, 15 49
• As many as 3,549 mothers and 2,460 children, 0-36
  months

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Measurements

• Antenatal care
• Type of antenatal care they sought (modern
  vs. traditional/none)
• Frequency in antenatal care utilization
• Child health (z-score) Standardized weights
  conditional on the median weight of a
  well-nourished child of the same age and sex in
  the US population.

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Estimation Strategy Two Staged

• 1st stage
• Antenatal caref(maternal and paternal
  education, controlsage, exposure to media,
  employment, religion, caste, urbanity, and
  regional controls)
• Estimation technique Binomial Logit Model
• Antenatal Visits f(maternal and paternal
  education, controlsage, exposure to media,
  employment, religion, caste, urbanity, and
  regional controls)
• Estimation technique Negative Binomial (count)
  Model
• 2nd stage
• Child healthf(predicted antenatal care,
  controlsmaternal height, weight, age, age at
  marriage childs sex, age, age-sq, parity,
  illness and immunization history households
  water-supply and sanitation conditions religion,
  caste)
• Estimation technique Ordinary Least Squares

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Results (Part I) Why isnt antenatal care
universal in Nepal?

• Maternal education Matters
• 15, 34, and 57 higher likelihood if a
• mother has five, ten, or at least twelve years
  of schooling than none
• Paternal education matters
• 7, 17, 12 higher likelihood if her husband has
  five, ten, or at least twelve years of schooling
  than none

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Results (Part II) Does antenatal care
utilization matter for child health?

• Yes and significantly
• Z-score increases by 0.1 if a mother utilizes
  antenatal care
• Z-score increases by 0.8 if she pays 1 more
  antenatal visit

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Discussion and Policy Implications

• Results robust to variations in sample and
  estimation techniques
• Maternal Education matters
• Paternal education, more important than the
  conventional wisdom suggests
• Raising awareness about importance of antenatal
  care
• Raising awareness about maternal health for child
  health
• Dissemination of health information