Publication: Why Rural Women Use—or Avoid—Maternal Health Services: Insights from a Qualitative Study in Bolivia
Loading...
Published
2020-11-09
ISSN
Date
2020-11-12
Author(s)
Editor(s)
Abstract
Bolivia has achieved significant improvements in its reproductive health indicators in recent years. Yet the country’s maternal mortality ratio, at 206 per 100,000 women in 2015, was the second highest in the Latin American and Caribbean region after Haiti. Bolivia’s indigenous women are particularly vulnerable to death from complications related to pregnancy, childbirth, and the post-partum period. In the past, there have been no studies that sought the views of health providers and users to understand and address this problem in rural indigenous communities. This study fills that gap by tapping this experiential knowledge in these communities in Bolivia and gain insights into supply- and demand-side barriers that keep women away from institutional maternal health services. Increasing their use of quality maternal care is vital to long-term goals to lower the country’s maternal mortality ratio. Both supply- and demand-side influences restrain the uptake of maternal health services by rural indigenous women. Strengthening the quality of maternal health services, including provider-user interactions, is a first and foremost priority that can be combined with targeted behavior change interventions to reduce community, household, and individual constraints on women seeking maternal health services.
Link to Data Set
Citation
“World Bank. 2020. Why Rural Women Use—or Avoid—Maternal Health Services: Insights from a Qualitative Study in Bolivia. © World Bank. http://hdl.handle.net/10986/34778 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Maternal Health Out-of-Pocket Expenditure and Service Readiness in Lao PDR : Evidence for the National Free Maternal and Child Health Policy from a Household and Health Center Survey(Washington, DC, 2013-10)Although Lao PDR has made notable progress in improving maternal and child health (MCH), attainment of the Millennium Development Goal 5 (MDG5) still remains a challenge. This is largely due to the barriers imposed by financial restrictions. In order to address these financial barriers, the Government of Lao PDR has introduced a national free MCH policy. However, certain non-financial barriers are also impediments to the achievement of this goal, such as physical access to remote communities, especially during rainy season, cultural practices and beliefs, and poor educational outcomes. In seeking to inform the implementation and scale-up of this national free MCH policy at this crucial initial stage, this paper reports on findings from a household, village and health center survey The policy implications of the findings from the survey are: 1) although financial protection implied by the national free MCH policy is strong, reducing financial barriers alone would not be sufficient to increase the utilization of services, 2) this policy has the potential to be regressive due to the higher utilization of MH services by wealthier households, 3) health providers at all levels of health facilities would experience substantial marginal decreases in revenue, given the reimbursement schedules under the national free MCH policy, and 4) the supply-side readiness and management capacity of health centers needs to be improved. This paper is organized to present the background context, analyses, the equity of MH service utilization, the supply-side perspective, and key findings and recommendations.Publication Trends in Maternal Mortality(Geneva: World Health Organization, 2015-12)In 2000, the United Nations (UN) Member States pledged to work towards a series of Millennium Development Goals (MDGs), including the target of a three-quarters reduction in the 1990 maternal mortality ratio (MMR; maternal deaths per 100 000 live births), to be achieved by 2015. This target (MDG 5A) and that of achieving universal access to reproductive health (MDG 5B) together formed the two targets for MDG 5: Improve maternal health. In the five years counting down to the conclusion of the MDGs, a number of initiatives were established to galvanize efforts towards reducing maternal mortality. These included the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, which mobilized efforts towards achieving MDG 4 (Improve child health) as well as MDG 5, and the high-level Commission on Information and Accountability (COIA), which promoted “global reporting, oversight, and accountability on women’s and children’s health”. Now, building on the momentum generated by MDG 5, the Sustainable Development Goals (SDGs) establish a transformative new agenda for maternal health towards ending preventable maternal mortality; target 3.1 of SDG 3 is to reduce the global MMR to less than 70 per 100 000 live births by 2030.Publication Republic of Congo : Enhancing Efficiency in Education and Health Public Spending for Improved Quality Service Delivery for All(Washington, DC, 2014-06)The development of a wealthier, literate, and healthy society is a fundamental goal of Congo's national development plan (NDP) 2012-16 and poverty reduction strategy paper (PRSP) 2012-16. Appropriate funding allocations and efficient use of funds in education and health are fundamental for the development of the sectors. This public expenditure review (PER) of the Congolese education and health sectors aims at providing inputs to improve efficiency and equity in spending in these sectors. It takes into account the following findings of the macro PER: (i) spending on the social sectors is still low although it has increased over time; (ii) the fiscal space generated by the increased oil revenues has largely boosted investment expenditure; and (iii) budget execution is low which contributes to lower the real level of public spending. The PER is divided in two main parts. Part I, constitutes an overview of the two sector reports. Thus, it presents a brief analysis of the context of the country, a summary of findings of the education and health PER, a discussion on cross-cutting themes on spending in the two sectors, and a summary of recommendations. Part II includes the education and health PER.Publication Increased Coverage of Maternal Health Services among the Poor in Western Uganda in an Output-Based Aid Voucher Scheme(World Bank, Washington, DC, 2016-06)Vouchers stimulate demand for health care services by giving beneficiaries purchasing power. In turn, health facilities’ claims are reimbursed for providing beneficiaries with improved quality of health care. Efficient strategies to generate demand from new, often poor, users and supply in the form of increased access and expanded scope of services would help move Uganda away from inequity and toward universal health care. A reproductive health voucher program was implemented in 20 western and southwest Ugandan districts from April 2008 to March 2012. Using three years of data, this impact evaluation study employed a quasi-experimental design to examine differences in utilization of health services among women in voucher and nonvoucher villages. Two key findings were a 16-percentage-point net increase in private facility deliveries and a decrease in home deliveries among women who had used the voucher, indicating the project likely made contributions to increase private facility births in villages with voucher clients. No statistically significant difference was seen between respondents from voucher and nonvoucher villages in the use of postnatal care services, or in attending four or more antenatal care visits. A net 33-percentage-point decrease in out-of-pocket expenditure at private facilities in villages with voucher clients was found, and a higher percentage of voucher users came from households in the two poorest quintiles. The greater uptake of facility births by respondents in voucher villages compared with controls indicates that the approach has the potential to accelerate service uptake. A scaled program could help to move the country toward universal coverage of maternal health care.Publication Maternal Health, Child Health and Nutrition in Lao PDR : Evidence from a Household Survey in Six Central and Southern Provinces(Washington, DC, 2013-06)Despite being on-track on the child- and maternal-health Millennium Development Goals (MDGs), Lao PDR continues to have some of the worst maternal and child health (MCH) and nutrition outcome indicators, both globally as well as in the East Asia and Pacific (EAP) region. This report presents results from a household, village, and facility survey on Maternal and Child Health (MCH) and nutrition in mostly rural areas of six central and southern provinces of Lao People's Democratic Republic (PDR). The information in this report localizes MCH and nutrition-related information that are typical for sampled catchment areas of selected health centers in six central and southern provinces of the country. In addition, the report summarizes data on service availability and readiness of health centers in terms of their ability to provide key MCH & nutrition-related services. The results from this survey thus shed light on what it would take to attain the health-related MDGs. In order to improve the level and equity of maternal and child health indicators, interventions would need to address numerous demand-side barriers, including physical access barriers, financial barriers, and cultural, linguistic, and educational barriers.
Users also downloaded
Showing related downloaded files
Publication Digital Progress and Trends Report 2023(Washington, DC: World Bank, 2024-03-05)Digitalization is the transformational opportunity of our time. The digital sector has become a powerhouse of innovation, economic growth, and job creation. Value added in the IT services sector grew at 8 percent annually during 2000–22, nearly twice as fast as the global economy. Employment growth in IT services reached 7 percent annually, six times higher than total employment growth. The diffusion and adoption of digital technologies are just as critical as their invention. Digital uptake has accelerated since the COVID-19 pandemic, with 1.5 billion new internet users added from 2018 to 2022. The share of firms investing in digital solutions around the world has more than doubled from 2020 to 2022. Low-income countries, vulnerable populations, and small firms, however, have been falling behind, while transformative digital innovations such as artificial intelligence (AI) have been accelerating in higher-income countries. Although more than 90 percent of the population in high-income countries was online in 2022, only one in four people in low-income countries used the internet, and the speed of their connection was typically only a small fraction of that in wealthier countries. As businesses in technologically advanced countries integrate generative AI into their products and services, less than half of the businesses in many low- and middle-income countries have an internet connection. The growing digital divide is exacerbating the poverty and productivity gaps between richer and poorer economies. The Digital Progress and Trends Report series will track global digitalization progress and highlight policy trends, debates, and implications for low- and middle-income countries. The series adds to the global efforts to study the progress and trends of digitalization in two main ways: · By compiling, curating, and analyzing data from diverse sources to present a comprehensive picture of digitalization in low- and middle-income countries, including in-depth analyses on understudied topics. · By developing insights on policy opportunities, challenges, and debates and reflecting the perspectives of various stakeholders and the World Bank’s operational experiences. This report, the first in the series, aims to inform evidence-based policy making and motivate action among internal and external audiences and stakeholders. The report will bring global attention to high-performing countries that have valuable experience to share as well as to areas where efforts will need to be redoubled.Publication Using Immunization Coverage Rates for Monitoring Health Sector Performance : Measurement and Interpretation Issues(World Bank, Washington, DC, 2000-08)Immunization against childhood diseases such as diphtheria, pertussis, tetanus, polio and measles is one of the most important means of preventing childhood morbidity and mortality. Despite the low cost of basic childhood immunizations, nearly 3 million children still die each year from vaccine-preventable diseases. Achieving and maintaining high levels of immunization coverage must therefore be a priority for all health systems. In order to monitor progress in achieving this objective, immunization coverage data can serve as an indicator of a health system's capacity to deliver essential services to the most vulnerable members of a population. This note discusses the use of trends in immunization coverage data, and argues that immunization is a health output with a strong impact on child morbidity, child mortality and permanent disability. This note discusses measurement and interpretation issues for coverage data collected through surveys and administrative records.Publication The Container Port Performance Index 2023(Washington, DC: World Bank, 2024-07-18)The Container Port Performance Index (CPPI) measures the time container ships spend in port, making it an important point of reference for stakeholders in the global economy. These stakeholders include port authorities and operators, national governments, supranational organizations, development agencies, and other public and private players in trade and logistics. The index highlights where vessel time in container ports could be improved. Streamlining these processes would benefit all parties involved, including shipping lines, national governments, and consumers. This fourth edition of the CPPI relies on data from 405 container ports with at least 24 container ship port calls in the calendar year 2023. As in earlier editions of the CPPI, the ranking employs two different methodological approaches: an administrative (technical) approach and a statistical approach (using matrix factorization). Combining these two approaches ensures that the overall ranking of container ports reflects actual port performance as closely as possible while also being statistically robust. The CPPI methodology assesses the sequential steps of a container ship port call. ‘Total port hours’ refers to the total time elapsed from the moment a ship arrives at the port until the vessel leaves the berth after completing its cargo operations. The CPPI uses time as an indicator because time is very important to shipping lines, ports, and the entire logistics chain. However, time, as captured by the CPPI, is not the only way to measure port efficiency, so it does not tell the entire story of a port’s performance. Factors that can influence the time vessels spend in ports can be location-specific and under the port’s control (endogenous) or external and beyond the control of the port (exogenous). The CPPI measures time spent in container ports, strictly based on quantitative data only, which do not reveal the underlying factors or root causes of extended port times. A detailed port-specific diagnostic would be required to assess the contribution of underlying factors to the time a vessel spends in port. A very low ranking or a significant change in ranking may warrant special attention, for which the World Bank generally recommends a detailed diagnostic.Publication Global Economic Prospects, January 2025(Washington, DC: World Bank, 2025-01-16)Global growth is expected to hold steady at 2.7 percent in 2025-26. However, the global economy appears to be settling at a low growth rate that will be insufficient to foster sustained economic development—with the possibility of further headwinds from heightened policy uncertainty and adverse trade policy shifts, geopolitical tensions, persistent inflation, and climate-related natural disasters. Against this backdrop, emerging market and developing economies are set to enter the second quarter of the twenty-first century with per capita incomes on a trajectory that implies substantially slower catch-up toward advanced-economy living standards than they previously experienced. Without course corrections, most low-income countries are unlikely to graduate to middle-income status by the middle of the century. Policy action at both global and national levels is needed to foster a more favorable external environment, enhance macroeconomic stability, reduce structural constraints, address the effects of climate change, and thus accelerate long-term growth and development.Publication Global Economic Prospects, June 2025(Washington, DC: World Bank, 2025-06-10)The global economy is facing another substantial headwind, emanating largely from an increase in trade tensions and heightened global policy uncertainty. For emerging market and developing economies (EMDEs), the ability to boost job creation and reduce extreme poverty has declined. Key downside risks include a further escalation of trade barriers and continued policy uncertainty. These challenges are exacerbated by subdued foreign direct investment into EMDEs. Global cooperation is needed to restore a more stable international trade environment and scale up support for vulnerable countries grappling with conflict, debt burdens, and climate change. Domestic policy action is also critical to contain inflation risks and strengthen fiscal resilience. To accelerate job creation and long-term growth, structural reforms must focus on raising institutional quality, attracting private investment, and strengthening human capital and labor markets. Countries in fragile and conflict situations face daunting development challenges that will require tailored domestic policy reforms and well-coordinated multilateral support.