Association of Household Savings and Expected Future Means with Delivery Using a Skilled Birth Attendant in Ghana and Nigeria: A Cross-Sectional Analysis
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Objectives This study examined the association between household savings and related economic measures with utilization of skilled birth attendants (SBAs) at last birth among women living in peri-urban households (n = 381) in Ghana and Nigeria. Methods Data were drawn from the 2011–2014 Family Health and Wealth Study. Multivariable logistic regression models were used to estimate the odds of delivery with an SBA for individual and composite measures of household savings, expected financial means, debt, lending, and receipt of financial assistance, adjusting for demographic and reproductive characteristics. Results Seventy-three percent (73 %) of women delivered with an SBA during their last birth (89 %, Ghana; 63 %, Nigeria), and roughly one third (34 %) of households reported having any in-cash or in-kind savings. In adjusted analyses, women living in households with savings were significantly more likely to deliver with an SBA compared to women in households without any savings (aOR = 2.02, 95 % CI 1.09–3.73). There was also a consistent downward trend, although non-significant, in SBA utilization with worsening financial expectations in the coming year (somewhat vs. much better: aOR = 0.70, 95 % CI 0.40–1.22 and no change/worse vs. much better: aOR = 0.46, 95 % CI 0.12–1.83). Findings were null for measures relating to debt, lending, and financial assistance. Conclusion Coupling birth preparedness and complication readiness strategies with savings-led initiatives may improve SBA utilization in conjunction with targeting non-economic barriers to skilled care use.
KeywordsSkilled birth attendance Institutional delivery Birth preparedness Savings Economic Obstetric
Adjusted odds ratio
Birth preparedness and complication readiness
Skilled birth attendant
The authors wish to thank the Family Health and Wealth Study (FHWS) participants for making this research possible. We are also grateful for support from the Bill & Melinda Gates Foundation though the Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. The presented conclusions are those of the authors and do not necessarily reflect the views of the funding body.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
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