TY - JOUR
T1 - Utilization of care during pregnancy in rural Guatemala
T2 - Does obstetrical need matter?
AU - Glei, Dana A.
AU - Goldman, Noreen
AU - Rodríguez, Germán
N1 - Funding Information:
We gratefully acknowledge support for this project from NICHD (Grants R01 HD27361, R01 HD31327, and P30 HD32030), and USAID (#HRN-A-00-97-000018-00) through UNC-CH (5-56127). The findings, opinions, and recommendations expressed here are those of the authors and not necessarily those of UNC-CH or USAID. The Guatemalan Survey of Family Health (EGSF) was a joint undertaking among RAND, Princeton University, and the Instituto de Nutrición de Centro América y Panamá (INCAP), directed by Dr. Hernán Delgado. We are grateful to Elena Hurtado, Marie Ruel, Hernán Delgado, and many INCAP staff for collaboration on the survey. We would also like to thank Marion Carter and two anonymous reviewers for their suggestions and comments on this manuscript.
PY - 2003/12
Y1 - 2003/12
N2 - This study examines factors associated with the use of biomedical care during pregnancy in Guatemala, focusing on the extent to which complications in an ongoing or previous pregnancy affect a woman's decisions to seek care. The findings, based on multilevel models, suggest that obstetrical need, as well as demographic, social, and cultural factors, are important predictors of pregnancy care. In contrast, measures of availability and access to health services have modest effects. The results also suggest the importance of unobserved variables-such as quality of care-in explaining women's decisions about pregnancy care. These results imply that improving proximity to biomedical services is unlikely to have a dramatic impact on utilization in the absence of additional changes that improve the quality of care or reduce barriers to access. Moreover, current efforts aimed at incorporating midwives into the formal health-care system may need to extend their focus beyond the modification of midwife practices to consider the provision of culturally appropriate, high-quality services by traditional and biomedical providers alike.
AB - This study examines factors associated with the use of biomedical care during pregnancy in Guatemala, focusing on the extent to which complications in an ongoing or previous pregnancy affect a woman's decisions to seek care. The findings, based on multilevel models, suggest that obstetrical need, as well as demographic, social, and cultural factors, are important predictors of pregnancy care. In contrast, measures of availability and access to health services have modest effects. The results also suggest the importance of unobserved variables-such as quality of care-in explaining women's decisions about pregnancy care. These results imply that improving proximity to biomedical services is unlikely to have a dramatic impact on utilization in the absence of additional changes that improve the quality of care or reduce barriers to access. Moreover, current efforts aimed at incorporating midwives into the formal health-care system may need to extend their focus beyond the modification of midwife practices to consider the provision of culturally appropriate, high-quality services by traditional and biomedical providers alike.
KW - Biomedical care
KW - Guatemala
KW - Multilevel models
KW - Pregnancy
KW - Pregnancy complications
KW - Prenatal care
UR - http://www.scopus.com/inward/record.url?scp=0142186767&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0142186767&partnerID=8YFLogxK
U2 - 10.1016/S0277-9536(03)00140-0
DO - 10.1016/S0277-9536(03)00140-0
M3 - Article
C2 - 14572850
AN - SCOPUS:0142186767
SN - 0277-9536
VL - 57
SP - 2447
EP - 2463
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 12
ER -