Do women increase their use of reproductive health care when it becomes more available? Evidence from Indonesia.
Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health-care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery--changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use.
Frankenberg
Elizabeth
E
Terry Sanford Institute of Public Policy, Duke University, 302 Towerview Road, RH 110, Durham, NC 27705, USA. e.frankenberg@duke.edu
Buttenheim
Alison
A
Sikoki
Bondan
B
Suriastini
Wayan
W
D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007214:Indonesia; D007407:Interviews as Topic; D007501:Iron / Q000008:administration & dosage; D016015:Logistic Models; D008137:Longitudinal Studies; D008427:Maternal Health Services / Q000379:methods / Q000706:statistics & numerical data*; D008880:Midwifery / Q000193:education / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data*; D034121:Reproductive Health Services / Q000706:statistics & numerical data
D007501:Iron