Hayley Heath and Dr. Renata Forste, Sociology
Access to maternal healthcare is seriously deficient in developing countries, particularly in rural areas of Africa. The World Health Organization (WHO) estimates that 515,000 women die each year from pregnancy related causes, and more than half of these deaths occur in Africa (Mavalankar & Rosenfield, 2005). “Safe motherhood is a key objective for developing countries but, despite recent improvements, sub-Saharan Africa is still the most dangerous place in the world to give birth” (Chambers & Booth, 2012). Although Africa as a continent has high maternal mortality, Rwanda is improving maternal health faster than any African country. Rwandan health policies have sought to improve health practices by increasing accessibility through the coordination of external aid and government policy; policy efforts have included monitoring the effectiveness of aid, a country-wide independent community health insurance scheme, and the introduction of a performance based pay initiative (Logie, Rowson, & Ndagije, 2008). In 2005 only 28% of women were giving birth at health facilities in Rwanda, whereas by 2010 the percent had risen to 69% (Chambers & Booth, 2012).
Given these policy initiatives, I examined how widespread the benefits of increased healthcare access have been in Rwanda; in particular whether access to prenatal care and delivery by trained healthcare providers has increased among all women, or just those with higher education and incomes. The aim of this project was to examine the scope of policies in Rwanda aimed at increasing maternal healthcare over the past two decades. Specifically to determine if greater access to maternal care has benefited women of all education and income levels, or if it continues to only benefit women with higher education and income.
This research was based on Demographic and Health Survey data from Rwanda in 2007 and 2010. The DHS are nationally-representative household surveys of women of childbearing age with a sample size of 17,651 women in Rwanda. Using logistic regression techniques in STATA, I studied the relationship between my dependent variable (maternal health care access: measured by delivery at a health center and deliver with a skilled birth attendant) and my independent variables (maternal education, wealth index, and urban/rural residence).
This research ultimately finds that increasing utilization of maternal health care is taking place among all women in Rwanda. Table 1 explains that in 2007, a woman with higher education was about 5 times more likely to deliver with a nurse/medical assistant than was a woman with incomplete primary education (1.494 = 4.92). While in 2010, following the implementation of the equalization health policies, the influence of education on use of a nurse was about 17 percent lower than in 2007 which is statistically significant. The influence for urban residence in 2007 was the most dramatic with urban women being 1.9 times more likely to deliver with a nurse/medical assistant. And in 2010 the urban women were only 1.2 times as likely to deliver with a nurse which is a significant 35 percent decrease since 2007.
Table 2 shows that the findings for utilization of a health center for delivery are much the same as use of medical staff to deliver a baby. Not only are the wealthy, educated, and urban women more likely to use a health center to deliver their baby, their poor and rural counterparts are more likely to as well. The table shows that the influence of urban living, wealth and education on utilization of health facilities decreased between 2007 and 2010.
Whether poor or wealthy, educated or not, rural or urban- all women and have the right to access safe professional care. Africa has experienced a history of unequal medical access for its women, granting it the most dangerous place in the world to give birth. To combat this, Rwanda is improving maternal health faster than any African country. Rwandan health policies have sought to improve health practices by increasing accessibility through the coordination of external aid and government policy. In 2005 only 28% of women were giving birth at health facilities in Rwanda, whereas by 2010 the percent had risen to 69% (Chambers & Booth, 2012). Given these extensive policy initiatives and the conducted research, the utilization of health care facilities and professional staff has dramatically increased since the implementation of these policies around 2007. In addition, this increasing utilization is taking place among all women in Rwanda. The benefits of increased healthcare have been widespread among all Rwandan women, not just those with higher education and incomes and urban residence.
The implications of this research is the need for further study to assess whether this drastic increase in maternal healthcare use can be attributed to the policy changes in totality. This could be done through using Rwanda’s policy changes and implementing them in other African countries. Rwanda is doing something right when it comes to maternal health care, more women are using it than in any other African country, and more types of women are able to do so.