Women in Transitional Countries: Effects of Household Autonomy on Utilization of Prenatal Services in Armenia and Aerbaiajan

Background and Purpose: With transition to market economies after the breakup of the Soviet Union, newly independent states faced numerous and previously unknown challenges, including economic disparities and sharp declines in social and health indicators. Transitional shocks were exacerbated by the lack of robust welfare systems in transitional countries. Armenia and Azerbaijan inherited social protection systems that were not designed to respond to needs of the vulnerable and poor population. Loss of employment and underdeveloped social services left women depending on family support for utilizing health care services. In this study, we explored how women’s decision-making autonomy at the household levels affected women’s health-seeking behaviors during pregnancy in Armenia and Azerbaijan. We hypothesized that autonomy positively affects utilization of prenatal services.

Methods: An index measure representing women’s autonomy in the household was constructed and used as the main predictor. Representative data from Armenia and Azerbaijan from 2005-2006 were used to analyze three outcomes related to utilization of prenatal care: a) timing of the first visit; b) number of the visits; 3) content of care. We controlled for the endogenous variance induced by the household structure on utilization outcomes, using instrumental variables methods.

Results: Contrary to existing evidence, household autonomy had a differential effect on utilization. Women with higher levels of autonomy had delayed their first visits and had fewer visits but they received more care. However, these effects were present only for women in positions of daughters-in-law or wives in the household structure.

Conclusions and Implications: Characteristics of women who had less favorable utilization outcomes were similar to the overall poverty profile outlined in national development strategies. Poverty was associated with high rates of unemployment in Armenia and Azerbaijan. In both countries, women were affected by poverty and unemployment more than men. Inability to gain access to assistance and the minimal amounts of cash assistance received by women could negatively influence their ability to seek prenatal care services or make a required number of visits. Social workers could assist in developing social policies for the transitional period, when large segments of the population are unable to have viable employment and many people are part of the informal labor market. A more targeted area for social work interventions in communities could be liaising health facilities with social assistance offices, so that women eligible for social assistance could receive primary health care free of charge. This intervention could assist in improving maternal health outcomes