(Luận văn thạc sĩ) maternal health care in vietnam demand for antenatal care and choice of delivery care services

UNIVERSITY OF ECONOMICS ERAMUS UNIVERSITY ROTTERDAM HO CHI MINH CITY INSTITUTE OF SOCIAL STUDIES VIETNAM THE NETHERLANDS VIETNAM - NETHERLANDS PROGRAMME FOR M.A IN DEVELOPMENT ECONOMICS MATERNAL HEALTH CARE IN VIETNAM: DEMAND FOR ANTENATAL CARE AND CHOICE OF DELIVERY CARE SERVICES By Nguyen Thi Hoai Trang A Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of Master of Art in Development Economics Academic Supervisor: Dr Truong Dang Thuy HO CHI MINH CITY, June 2016 DECLARATION “This is to certify that this thesis entitled “MATERNAL HEALTH CARE IN VIETNAM: DEMAND FOR ANTENATAL CARE AND CHOICE OF DELIVERY CARE SERVICES”, which is submitted by me in fulfillment of the requirements for the degree of Master of Art in Development Economics to the Vietnam – The Netherlands Programme (VNP) The thesis constitutes only my original work and due supervision and acknowledgement have been made in the text to all materials used HCMC, June 06th, 2016 Nguyen Thi Hoai Trang i ACKNOWLEDGEMENT I would like to acknowledge my supervisor, Dr Truong Dang Thuy for his great contribution to my thesis Without his support, my thesis would be not possible By his large knowledge and experiences, he gave me the informative comments and enabled me to understand my work better I would like to express my sincere gratitude to his guidance and encouragement, which make me stronger to overcome the challenges and fulfill my work completely By this chance, I would like to express my appreciation toward all lecturers of the Vietnam – Netherlands Program who have provided with valuable economic knowledge during my study in this program Next, I wish to thank to all my friends here at VNP- MDE 19, who share unforgettable memories in studying together Finally, I would like to express my deep gratitude to my family for their support and endurance when I pursue my postgraduate studies ii ABSTRACT This thesis research aims to analyze the impact of individual characteristics, household characteristic and communities in utilization of maternal health care services in Vietnam Using the latest data of Vietnam’s Multiple Indicator Cluster Survey 2013-2014, it employs the Negative Nominal Model for demand of prenatal care visits and Multinomial Logistic Model for the choice of delivery facility With respect to the demand of prenatal care visits, the result shows that higher education, higher age, exposure to mass media and no religion increase the number of prenatal care visits while higher birth order, unmarried or separated status, ethnicity group and lower household wealth index decrease the number of prenatal care Moreover, living in rural, disadvantaged areas and the community with higher illiteracy rate decrease the demand of prenatal care visits while living in the community with higher proportion of women giving birth at health facilities increase the demand Concerning the choice of delivery facility, more prenatal care visits and exposure to mass media are positively associated with the choice of giving birth at public hospital In contrast, suffering the burden of taking care more children, lower household wealth index, living in rural and the community with higher illiteracy ratio adversely affect the choice of public hospital delivery The results suggest the improvement of maternal health program in rural and underdeveloped areas as well as universal education over the country, especially for the ethnic minority group Keywords: prenatal care visits, the place of childbirth, individual characteristics, household characteristics, community characteristics, Vietnam iii Contents DECLARATION i ACKNOWLEDGEMENT ii ABSTRACT iii LIST of TABLES and FIGURES vii ABBREVIATION viii CHAPTER I INTRODUCTION 1.1 Problem statement 1.2 Research objectives 1.3 Research questions 1.4 Structure CHAPTER II LITERATURE REVIEW 2.1 The role of maternity health care 2.2 Overview of maternal health and health care in Vietnam 2.2.1 The culture 2.2.2 The two-child policy 2.2.3 Maternal mortality ratio and maternal health care in Vietnam 2.3 The demand for health care 11 2.3.1 Theoretical background 11 2.3.2 Empirical Literature Review 13 2.4 The choice of health care provider 19 2.4.1 Theoretical background: 19 iv 2.4.2 Empirical literature review 20 CHAPTER III 23 METHODOLOGY AND DATA DESCRIPTION 23 3.1 Conceptual framework 24 3.2 Empirical framework 25 3.2.1 Demand for Prenatal care 26 3.2.2 Choice of birth delivery facility 27 3.3 Data 28 3.4 Variables definition 28 3.4.1 Dependent variables 28 3.4.2 Independent variables 29 RESULTS AND DISCUSSIONS 31 4.1 Descriptive Results 32 4.2 Analysis of Demand for prenatal care 34 4.2.1 Bivariate analysis 34 4.2.2 Analysis of Negative Binomial Model 37 4.3 Analysis of Choice in the delivery care providers 41 4.3.1 Bivariate analysis 41 4.3.2 Analysis of Multinomial Logistic Model 44 CHAPTER V 47 CONCLUSION, RECOMMENDATION and LIMITATION 48 5.1 Main findings 48 5.2 Policy Recommendation 49 5.3 Limitation and Further Research 50 v REFERENCE 51 APPENDIX 56 STATA RESULTS 71 vi LIST of TABLES and FIGURES List of Tables Table 1: Description of Variables 30 Table 2:Descriptive Results – Numeric Variables 33 Table : Descriptive Results - Dummy Variables 33 Table 4: Bivariate analysis in the demand of prenatal care visits 35 Table 5: Negative binomial regression for the demand of prenatal care visits 40 Table : Bivariate analysis in the choice of delivery care providers - numeric independent variables 41 Table 7:Bivariate analysis in the choice of delivery care provider – dummy independent variables 43 Table 8: Multinomial Logistic Regression for the choice of delivery care provider 46 Table 9: Marginal effects for the choice of delivery care provider 47 List of Figures Figure 1: MMR in Vietnam in the period of 2000 – 2015 Figure 2: MMR of the Asian countries in the period of 2000 – 2015 Figure 3: Percentage of women having at least visit and at least visits during pregnancy Figure 4: The percentage of the women taking antenatal care visits by residence in 2011 and 2014 10 Figure 5: The percentage of the women taking antenatal care visits by ethnicity in 2011 and 2014 10 Figure The association between individual level, household level and community level characteristics with the utilization of maternal health care services 25 Figure 7: The association between the demand of maternal care visits and numerical independent variables 37 vii ABBREVIATION ANC Antenatal Care CSDH Commission on Social Determinants on Heath GSO General Statistics Office IMR Infant Mortality Ratio MDGs Millennium Development Goals MICS Multiple indicator cluster survey MMR Maternal Mortality Ratio WHO World Health Organization viii CHAPTER I INTRODUCTION 1.1 Problem statement There is a growing concern about the maternal health care globally, especially in low income countries World Health Organization (WHO 2014) reported that the global maternal mortality ratio (MMR) in 2013 was 210 maternal deaths per 100 000 live births, decreasing from 380 maternal deaths per 100 000 live births in 1990 However, the ratio in developing regions was 14 times higher than in developed regions Even though maternal death is generally decreasing worldwide, it has yet to achieve the target of Millennium Development Goal by reducing the MMR by three quarters between 1990 and 2015 (WHO 2014) The maternal death has direct causes and indirect causes The direct cause results from arising complications during pregnancy, delivery and postpartum, or improper treatment such as hemorrhage, infection, obstructed labor, unsafe abortion, ectopic pregnancy and anesthesiarelated deaths while the indirect cause results from the disease which previously exists or be not due to indirect obstetric causes like hepatitis anemia, malaria, heart disease and tetanus (WHO 2005) It was reported that direct causes made up the higher number of maternal death than indirect causes with 80% of the total MMR (WHO 2005) These complications could be preventable thanks to the intervention of health care such as antenatal care and delivery care, which was introduced by WHO in the safe motherhood package in 1994 (Tran 2012) Antenatal cares provide the opportunities to pregnancy women and their family to be informed of their health and the growth status of unborn baby Low birth weights could be prevented if the pregnant women are well acknowledged about their unborn baby’s weight and height during the antenatal care and then improve their diet In addition, antenatal check-ups detect the danger signs and risks of pregnancy and delivery and make timely interventions For example, tetanus immunization in the antenatal care period is vital to save the life of the women and their baby The management of high blood pressure during pregnancy ensures the maternal health and increase the infant survival (WHO and UNICEF 2003) Furthermore, delivery care also plays an important role in reducing maternal deaths WHO recommended the child birth at health facility or attended by skilled health staffs to ensure to the safe delivery and give birth to healthy baby With good hygiene and adequate medical equipment, the delivery at facility could decrease the complications arising from the ... ? ?MATERNAL HEALTH CARE IN VIETNAM: DEMAND FOR ANTENATAL CARE AND CHOICE OF DELIVERY CARE SERVICES? ??, which is submitted by me in fulfillment of the requirements for the degree of Master of Art in. .. maternal health care in Vietnam The next part is to present the theoretical background for the demand for health care services, and the choice of health care facility and their determinants The final... review and empirical review regarding the demand for prenatal care visits and the choice of facility for delivery The first part is to provide the role of maternal health care and the overview of maternal