Increasing Women's Utilization of Health Services: a Case of Nepal

Purpose: It is estimated that over 500,000 women die annually due to maternity complications and most of these deaths occur in the developing countries (United Nations, 2000). Literature suggests that maternal mortality directly affects mortality of children; when a mother dies, mortality rate of her children especially those under the age of five increases substantially. Nearly all studies examining health service utilization support that preventive visit to health services improve overall health and reduce maternal mortality substantially. Since the 1980s, many developing countries have expanded their primary health facilities to improve access to maternal and child health services. But the disparity in use of these health services is not very well understood. In this paper, we answer the following question: What is relationship between women's empowerment and their utilization of health services, including overall care, antenatal care, delivery care, and postnatal care? Methods: We utilize nationally representative sample of 10,793 women between the ages of 15 and 49 from one country, Nepal to understand the factors that contribute to their use of health services. We relied upon human capital theory and Anderson's behavioral model of health services use to select the list of variables. We analyzed the weighted data using the STATA statistical software and conducted univariate, bi-variate and multiple logistic regression. Results: Findings from multiple logistic regression showed that two of the empowerment related variables--women's education and knowledge about sexually transmitted diseases—significantly increased utilization of health services controlling for other factors (including demographic, economic, regional, health needs, and health behavior). For example, women with primary education were 22% more likely to have visited health facility in the past 12 months compared to women without any education. Similarly, of the women who had given birth in the past five years, antenatal care utilization was 77% higher among women with primary education compared to women without any education. Other such empowerment variables as women's access to cash income and their participation in financial decisions concerning household and health care were not significant after controlling for other variables in the model. Implications: Not surprisingly, educated and informed Nepalese women were using health services at a substantially higher level compared to those without education or information. In countries like Nepal where over 50% of the sample had no education and a similar percentage of women had not heard about sexually transmitted diseases, increasing access to health services would be difficult without promoting girls' education. This study implies that to increase the utilization of health facilities and to reduce maternal and child mortality, Nepal should not only increase women's access to public health facilities but also girls' access to education. Disparity in health service utilization among adult women may be reduced by improving information dissemination about diseases, including sexually transmitted diseases.