Predictors of antenatal health service utilization among left-behind wives of male outmigrants: Evidence from Patna District, India

Abstract

Objective: To analyze the sociological support system available for left-behind wives of male outmigrants and develop a model that predicts the antenatal care (ANC) services utilization.

Methods: A cross-sectional survey was conducted in rural regions of the Patna district, India. The sample size (n=328) was estimated using Cochran's formula. Five parameters of the social support system were identified (autonomy, spousal support, family support, social circle support, and government support). The score for each was calculated as a composite score using multiple variables; these served as independent variables. The respondents were categorized as efficient and non-efficient users of ANC service based on established criteria.

Results: The regression results showed that four out of five social parameters had a significant effect on ANC behavior. Spousal support was the strongest predictor (standardized regression coefficient β=0.57, OR 1.16, 95% CI 1.08-1.79, P=0.007). Government support was found to be the second strongest predictor (β=0.40, OR 1.49, 95% CI 1.04-2.14, P=0.027), followed by family support (β=0.31, OR 1.36, 95% CI 1.23-2.57, P=0.034) and autonomy (β=0.11, OR 1.32, 95% CI 1.11-2.26, P=0.030). The social circle support was found to be non-significant in predicting ANC behavior (P>0.05).

Conclusions: The policymakers could focus on the identified predictors to strengthen and modify the existing policies for left-behind wives of male outmigrants. The need of the hour is a strategic intervention for behavioral modification of not only the left-behind wives but also their family members along with reinforcement of the existing social-security net. One strategy we suggest is to launch an awareness campaign focusing on husbands (male outmigrants) and family members.

Keywords

Antenatal health / Reproductive behavior / Antenatal care utilization / South-East Asia / Left-behind wife

Conflict of interest statement

The authors have disclosed no conflicts of interest.

Funding

The IIHMR University Ph.D. fellowship was received to conduct this study.

Authors' contributions

The survey was conducted by Fahad Afzal. Both authors, Fahad Afzal and Arindam Das contributed equally in analysis and preparation of the manuscript.

Publisher’ s Note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

[1] World Health Organization-Health factsheet. Newborns: Improving survival and well-being. 2020. [Online] Available from:https://www.who.int/news-room/fact-sheets [Accessed 1st June 2023].

[2] Singh C, Basu R. Moving in and out of vulnerability: Interrogating migration as an adaptation strategy along a rural-urban continuum in India. Geogr J 2020; 186(1): 87-102.

[3] International Institute for Population Sciences. National Family Health Survey, India. Round-5. 2021. [Online] Available from: http://rchiips.org/nfhs/ [Accessed 1st June 2023].

[4] Mallick A. Prevalence of low birth weight in India and its determinants: Insights from the National Family Health Survey (NFHS). Anthropol Anz 2021; 78(3): 163-175.

[5] Zhao P, Han X, You L, Zhao Y, Yang L, Liu Y. Maternal health services utilization and maternal mortality in China: A longitudinal study from 2009 to 2016. BMC Pregnancy Childbirth 2020; 20(1): 1-10.

[6] Tekelab T, Chojenta C, Smith R, Loxton D. The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2019; 14(9): e0222566.

[7] Aryal N, Regmi PR, Van Teijlingen E, Trenoweth S, Adhikary P, Simkhada P. The impact of spousal migration on the mental health of Nepali women: A cross-sectional study. Int J Environ Res Public Health 2020; 17(4): 1292.

[8] Afzal F, Das A, Ali QA. Reproductive health of outmigrant's left-behind wives residing in Indian subcontinent - A systematic review encompassing mental stress, autonomy and patriarchy. Neuroquantology 2022; 20(7): 2719-2726.

[9] Imran K, Devadason ES, Kee-Cheok C. Developmental impacts of remittances on migrant-sending households: Micro-level evidence from Punjab, Pakistan. J South Asian Dev 2019; 14(3): 338-366.

[10] Mahapatro SR. Impact of labour migration on socioeconomic position of left-behind women in Bihar. Indian J Labour Econ 2018; 61(4): 701-718.

[11] Lei L, Desai S. Male out-migration and the health of left-behind wives in India: The roles of remittances, household responsibilities, and autonomy. Soc Sci Med 2021; 280: 113982.

[12] Bhagat RB, Ali I. Migration and impact of remittances on health. Muslims in Telangana: A discourse on equity, development, and security. Springer Nature 2021; 197-210. doi: 10.1007/978-981-33-6530-8_10.

[13] Archana R. Impact of male outmigration on left-behind women and families: A case study of Bihar. PhD thesis. IIPS, Mumbai; 2005.

[14] Kumar G, Choudhary TS, Srivastava A, Upadhyay RP, Taneja S, Bahl R, et al. Utilisation, equity and determinants of full antenatal care in India: Analysis from the National Family Health Survey 4. BMC Pregnancy Childbirth 2019; 19(1): 1-9.

[15] Paudel S, Paudel T, Sanjel S. Utilization of antenatal care services and factors affecting antenatal care visits in Pokhara sub-metropolitan city. J Karnali Academy Health Sci 2020; 3(1): 1-12.

[16] Cisse S, Rossier C, Sauvain-Dugerdil C. Women's personal networks and recourse to prenatal care in Bamako. J Demogr Economics 2022; 88(2): 195-216.

[17] Saggurti N, Atmavilas Y, Porwal A, Schooley J, Das R, Kande N, et al. Effect of health intervention integration within women's self-help groups on collectivization and healthy practices around reproductive, maternal, neonatal and child health in rural India. PLoS One 2018; 13(8): e0202562.

[18] Singh R, Neogi SB, Hazra A, Irani L, Ruducha J, Ahmad D, et al. Utilization of maternal health services and its determinants: A cross-sectional study among women in rural Uttar Pradesh, India. J Health Popul Nutr 2019; 38: 1-2.

[19] Kumari R, Shipra K. Role of ASHA to aware about antenatal care and post-natal care services are utilized by women beneficiaries registered in JSY (Janani Suraksha Yojana) in Samastipur district in Bihar. J Pharmacogn Phytochem 2020; 9(3s): 36-38.

[20] Pathak PK, Chaudhary N, Mishra S, Ayub A. Utilization of antenatal care services in rural population of north India: A cross sectional study. Int J Community Med Public Health 2020; 7(12): 5015-5020.

[21] Singh RK, Patra S. Differentials in the utilization of antenatal care services in EAG states of India. Int Res J Soc Sci 2013; 2(11): 28-32.

[22] Chatterjee E, Sennott C. Fertility intentions and maternal health behavior during and after pregnancy. Popul Stud 2020; 74(1): 55-74.

[23] Choithani C. Understanding the linkages between migration and household food security in India. Geogr Res 2017; 55(2): 192-205.

[24] Desai S, Banerji M. Negotiated identities: Impact of male migration on women. J Popul Res 2008; 25(3): 337-355.

[25] Afzal F, Aalam KP, Mehra S, Joshi S, Ahmad AA. Practice and awareness of migrant pregnant women living in urban slums towards tobacco consumption. Med Sci 2022; 26(125): ms316e2332. doi: 10.54905/disssi/v26i125/ms316e2332.

[26] Kalkan I. The impact of nutrition literacy on the food habits among young adults in Turkey. Nutr Res Pract 2019; 13(4): 352-357.

[27] Barman B, Saha J, Chouhan P. Impact of education on the utilization of maternal health care services: An investigation from National Family Health Survey (2015-16) in India. Child Youth Serv Rev 2020; 108: 104642.

[28] Ahmed S. Women left behind: Migration, agency, and the Pakistani woman. Gend Soc 2020; 34(4): 597-619.

[29] Alomair N, Alageel S, Davies N, Bailey JV. Factors influencing sexual and reproductive health of Muslim women: A systematic review. Reprod Health 2020; 17(1): 1-5.

[30] Scott K, Shinde A, Ummer O, Yadav S, Sharma M, Purty N, et al. Freedom within a cage: How patriarchal gender norms limit women's use of mobile phones in rural central India. BMJ Global Health 2021; 6(5s): e005596.

[31] Afzal F, Raychaudhuri PS, Afzal MA, Ahmad AA. Challenges faced by BPL population in availing public healthcare-analysing government initiatives, technology and cultural barriers in Aligarh district, UP. South Asian J Soc Sci Humanities 2021; 2(5): 1-19. doi: 10.48165/sajssh.2021.2501%20.

[32] Fulpagare PH, Saraswat A, Dinachandra K, Surani N, Parhi RN, Bhattacharjee S, et al. Antenatal care service utilization among adolescent pregnant women-evidence from Swabhimaan programme in India. Frontiers in Public Health 2019; 7: 1-19. doi: 10.3389/fpubh.2019.00369.

[33] Nagdev N, Ogbo FA, Dhami MV, Diallo T, Lim D, Agho KE. Factors associated with inadequate receipt of components and non-use of antenatal care services in India: A regional analysis. BMC Public Health 2023; 23(6): 1-17. doi: 10.1186/s12889-022-14812-3.

[34] Ministry of Health and family Welfare, GoI. Guidelines for control of iron deficiency anaemia. 2013:29-30. [Online] Available from:https://www.nhm.gov.in/images/pdf/programmes/child-health [Accessed 2nd June 2023].