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Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context

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  • Luginaah, Isaac N.
  • Kangmennaang, Joseph
  • Fallah, Mosoka
  • Dahn, Bernice
  • Kateh, Francis
  • Nyenswah, Tolbert

Abstract

In Liberia, 75% of those who died from 2014 Ebola epidemic were women and the effects of this gruelling epidemic were more severely felt by pregnant women. This immediately raised fears about the long-term impacts of the epidemic on maternal and child health. As part of a larger study, this paper uses Andersen’s behavioural model of health care utilization and Goffman’s stigma theory to explain the timing and utilization of maternal health services before the outbreak of the Ebola epidemic as a background to the potential long-term effects on maternal health. We conducted survival and multiple regression analysis using the 2007 (N = 3524) and 2013 (N = 5127) Liberia’s Demographic and Health Survey (LDHS) data. Our sample consisted of women of reproductive age (15–49 years) that had given birth in the last five years preceding the survey year. The findings show that from 2007 to 2013, there was an overall improvement in the timing of first antenatal care (ANC) visits (TR = 0.92, p < 0.001), number of ANC visits and delivery with skilled birth attendants. The results also show county and regional disparities in the utilization of ANC services with South Eastern A region emerging as a relatively vulnerable place. Also, access to ANC services defined by distance to a health facility strongly predicted utilization. We argue that the Ebola epidemic likely eroded many of the previous gains in maternal health care, and may have left a lingering negative effect on the access and utilization of maternal health services in the long-term. The study makes relevant policy recommendations.

Suggested Citation

  • Luginaah, Isaac N. & Kangmennaang, Joseph & Fallah, Mosoka & Dahn, Bernice & Kateh, Francis & Nyenswah, Tolbert, 2016. "Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context," Social Science & Medicine, Elsevier, vol. 160(C), pages 75-86.
    • Handle: RePEc:eee:socmed:v:160:y:2016:i:c:p:75-86
    DOI: 10.1016/j.socscimed.2016.05.019
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    2. Kpienbaareh, Daniel & Atuoye, Kilian N. & Ngabonzima, Anaclet & Bagambe, Patrick G. & Rulisa, Stephen & Luginaah, Isaac & Cechetto, David F., 2019. "Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs?," Social Science & Medicine, Elsevier, vol. 226(C), pages 164-175.
    3. Laura K. Merrell & Sarah R. Blackstone, 2020. "Women’s Empowerment as a Mitigating Factor for Improved Antenatal Care Quality despite Impact of 2014 Ebola Outbreak in Guinea," IJERPH, MDPI, vol. 17(21), pages 1-18, November.
    4. Gizelis, Theodora-Ismene & Karim, Sabrina & Østby, Gudrun & Urdal, Henrik, 2017. "Maternal Health Care in the Time of Ebola: A Mixed-Method Exploration of the Impact of the Epidemic on Delivery Services in Monrovia," World Development, Elsevier, vol. 98(C), pages 169-178.
    5. Bianca R Ziegler & Moses Kansanga & Yuji Sano & Joseph Kangmennaang & Daniel Kpienbaareh & Isaac Luginaah, 2021. "Antenatal care and skilled birth in the fragile and conflict‐affected situation of Burundi," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(4), pages 1081-1106, July.
    6. Aboud, Frances E. & Rahman, Ehsanur & Kassam, Rosemin & Khan, Jasmin & Ali, Nabeel Ashraf & Taleb, Fahmida, 2017. "Interrupting pathways to sepsis: Effectiveness of an intervention to reduce delays in timely care for sick children in rural Bangladesh," Social Science & Medicine, Elsevier, vol. 177(C), pages 269-277.
    7. Kangmennaang, Joseph & Onyango, Elizabeth O. & Luginaah, Isaac & Elliott, Susan J., 2018. "The next Sub Saharan African epidemic? A case study of the determinants of cervical cancer knowledge and screening in Kenya," Social Science & Medicine, Elsevier, vol. 197(C), pages 203-212.
    8. Ziegler, Bianca R. & Kansanga, Moses & Sano, Yuji & Kangmennaang, Joseph & Kpienbaareh, Daniel & Luginaah, Isaac, 2020. "Antenatal care utilization in the fragile and conflict-affected context of the Democratic Republic of the Congo," Social Science & Medicine, Elsevier, vol. 262(C).
    9. Theodora-Ismene Gizelis & Xun Cao, 2021. "A security dividend: Peacekeeping and maternal health outcomes and access," Journal of Peace Research, Peace Research Institute Oslo, vol. 58(2), pages 263-278, March.

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