[Poverty and sociocultural factors in the use of maternal health services in Ivory Coast].
BACKGROUND
Better health for populations is linked to the adequate access to health services. This is particularly important in developing countries, where a number of economic, social, and geographic barriers exist. Pregnant women are particularly at risk, as they have many health needs and problems. In addition, the use of maternal health services is particularly influenced by economic and socio-cultural factors. Therefore, we intended to appreciate the association between poverty, socio-cultural factors and use of maternal health services in Ivory Coast.


METHODS
For this study, our data were from the demographic and health survey in Ivory Coast in 1998. We used the logistic regression models to analyze the relation between poverty, socio-cultural factors and use of services (antenatal care, type of delivery).


RESULTS
62.4% of women used antenatal care adequately and 48.9% delivered in good conditions. Poverty is strongly linked to the use of services whatever the socio-cultural and demographic aspects are, with the poor using less services than the richer. Concerning the impact of socio-cultural characteristics, women living alone or with one adult (OR=1.60; 95% IC=1.06-2.42), those who are Christian (OR=1.83; 95% IC=1.25-2.67) or Akan are more likely to have adequate antenatal care than women living with 5 adults or more, having traditional or no religion, and those who are Senoufo or non Ivorian. Besides, when the number of children increases, they are less likely to consult. Primiparous, Christians (OR=2.45; 95% IC=1.68-3.59) or Muslims (OR=1.73; 95% IC=1.10-2.72) are more likely to deliver in a health center with a qualified assistance.


CONCLUSIONS
Poverty has a negative effect on the use of maternal services but one should also take into account certain socio-cultural characteristics, namely number of adults in the household, parity, ethnicity and religion. While reducing poverty, it appears important to involve family members and religious or ethnic leaders in order to improve this use.
Koné-Péfoyo
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Département de Médecine Sociale et Préventive, Local 3118, Pavillon 1420 - Mont-Royal, Université de Montréal, 1420, boulevard du Mont-Royal, Outremont, Québec, Canada. anna.josette.kone@umontreal.ca
Rivard
M
M
D000293:Adolescent; D000328:Adult; D007560:Cote d'Ivoire; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data