Maternal education and childbirth care in Uganda.

BACKGROUND: Globally, over 500,000 females die of complications related to pregnancy and childbirth each year, and of these, over 99% of deaths occur in developing countries such as Uganda. Utilisation of modern and professional care during delivery is important in lowering maternal mortality. This paper sets out to investigate the factors associated with the utilisation of modern and professional childbirth care so as to inform policy makers on the pertinent factors that need to be influenced by policy.
METHOD: A nationally representative Uganda Demographic and Health Survey (UDHS) (2006) was used. Sampling was done in two stages. In the first stage 321 clusters were selected from a list of clusters sampled in the 2005/06 Uganda National Household Survey (UNHS), 17 clusters from the 2002 Census frame from Karamoja, and 30 internally displaced camps (IDPs). In the second stage, the households in each cluster were selected as per the UNHS listing. In addition an additional 20 households were randomly selected in each cluster. Questionnaires were used during data collection. During the analysis, a maximum likelihood probit technique was employed. Prior to this, a bivariate approach was used to generate average percentages of mothers using the childbirth care services by background characteristics.
RESULTS: It is found that maternal education is the strongest predictor, especially at post-secondary level (highest marginal effect of 33% and P<0.01), associated with the utilisation of childbirth care. Whereas partner's education at all levels is important, maternal education is observed to exert a much stronger association. Other factors significantly associated with the utilisation of professional childbirth care include community infrastructure, occupation, location, and regional differences, wealth status, religion, and age cohorts.
CONCLUSION: These findings suggest that whereas all levels of education are important, the effects of post-secondary education are more pronounced. Therefore, efforts to improve professional childbirth care utilisation need to focus on female education beyond secondary level. In addition, measures are needed to improve agricultural productivity which might improve earnings and childbirth care utilisation. Government should also undertake to improve community infrastructure across all regions and locations. Both government and donors can ensure universal access to professional childbirth care irrespective of the ability to pay.