Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo

Elianna T. Kaplowitz, Kevin P. Fiori, Molly E. Lauria, Sesso Gbeleou, Agnés Miziou, Etonam Sowu, Jennifer Schechter, Heidi E. Jones

Research output: Contribution to journalArticle

Abstract

Introduction: Implementation of community-based healthcare services offering effective contraception, antenatal care (ANC), and treatment for symptomatic children under five has reduced maternal and child mortality in Togo. However, understanding if women are utilizing these services differentially based on social or demographic factors is important. This study identifies whether sexual relationship and socio-demographic factors are associated with healthcare utilization in four health facility catchment areas. Methods: We conducted a cross-sectional household survey of women aged 15–49 in four health facility catchment areas in 2016 (three rural sites, one urban site). We used multivariable Poisson regression to test whether socio-demographic factors and a validated sexual relationship power scale were associated with contraceptive use, ANC visits, and seeking treatment for symptomatic children under five. Results: Among women not pregnant or desiring pregnancy, older age, lower education, and single relationship status were associated with lower use of effective contraception. Among women who gave birth in two years preceding survey, low relationship power and low wealth quintile were associated with being less likely to attend at least four ANC visits. Women in rural sites were slightly more likely than women in the urban site to report seeking treatment for child under five with malaria, pneumonia, and/or diarrhea symptoms in last 2 weeks. Discussion: Interventions in low-resource settings should explore ways to reach women with low health-service utilization to improve contraceptive use, ANC visits, and treatment for sick children. Furthermore, age, education, marital status, wealth status and sexual relationship power must be considered when targeting maternal health behaviors. Trial Registration: ClinicalTrials.gov Identifier: NCT03773913; Date of registration: 12 Dec. 2018

Original languageEnglish (US)
Pages (from-to)845-855
Number of pages11
JournalMaternal and child health journal
Volume24
Issue number7
DOIs
StatePublished - Jul 1 2020

Keywords

  • Antenatal care
  • Care seeking
  • Child mortality
  • Contraception
  • Sexual relationship power
  • Togo

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health

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