title: Association of Household Savings and Expected Future Means with Delivery Using a Skilled Birth Attendant in Ghana and Nigeria: A Cross-Sectional Analysis.
abstract: Objectives This study examined the association between household savings and related economic measures with utilization of skilled birth attendants (SBAs) at last birth among women living in peri-urban households (n = 381) in Ghana and Nigeria. Methods Data were drawn from the 2011-2014 Family Health and Wealth Study. Multivariable logistic regression models were used to estimate the odds of delivery with an SBA for individual and composite measures of household savings, expected financial means, debt, lending, and receipt of financial assistance, adjusting for demographic and reproductive characteristics. Results Seventy-three percent (73 %) of women delivered with an SBA during their last birth (89 %, Ghana; 63 %, Nigeria), and roughly one third (34 %) of households reported having any in-cash or in-kind savings. In adjusted analyses, women living in households with savings were significantly more likely to deliver with an SBA compared to women in households without any savings (aOR = 2.02, 95 % CI 1.09-3.73). There was also a consistent downward trend, although non-significant, in SBA utilization with worsening financial expectations in the coming year (somewhat vs. much better: aOR = 0.70, 95 % CI 0.40-1.22 and no change/worse vs. much better: aOR = 0.46, 95 % CI 0.12-1.83). Findings were null for measures relating to debt, lending, and financial assistance. Conclusion Coupling birth preparedness and complication readiness strategies with savings-led initiatives may improve SBA utilization in conjunction with targeting non-economic barriers to skilled care use.
authors.affiliation: Program in Social and Behavioral Interventions, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA. ljennin6@jhu.edu.
authors.forename: Larissa
authors.initials: L
authors.lastname: Jennings
authors.affiliation: Program in Social and Behavioral Interventions, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA.
authors.forename: Fan
authors.initials: F
authors.lastname: Yang
authors.affiliation: School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Easmon
authors.initials: E
authors.lastname: Otupiri
authors.affiliation: Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ife, Nigeria.|School of Research and Postgraduate Studies, Faculty of Human and Social Sciences, North West University (Mafikeng Campus), Mmabatho, South Africa.
authors.forename: Ambrose
authors.initials: A
authors.lastname: Akinlo
authors.affiliation: Fertility Research and Endocrinology Unit, Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Oyo State, Nigeria.
authors.forename: Michael
authors.initials: M
authors.lastname: Okunlola
authors.affiliation: Department of Population, Family, and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hindin
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000191:economics*; D005191:Family Characteristics; D005260:Female; D005869:Ghana; D006700:Home Childbirth / Q000191:economics*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D008880:Midwifery / Q000706:statistics & numerical data*; D009549:Nigeria; D011247:Pregnancy; D012959:Socioeconomic Factors
keywords: Birth preparedness; Economic; Institutional delivery; Obstetric; Savings; Skilled birth attendance