Individual And Community Level Socioeconomic Associates Influencing Utilization Of Skilled Birth Attendance In Pakistan A Multilevel Analysis
Skilled birth attendance is one of the major public health challenges under the domain of mother and child health in the context of Pakistan. Several studies have been conducted in Pakistan identifying the underlying reasons that lead to the low Skilled Birth Attendance rate at individual level yet there remains gap in terms of approaching this subject by involving contextual factors in the analysis. This study attempts to bridge this gap by including community level factors along with individual factors that might be correlated with utilization of Skilled Birth Attendance in Pakistan. Data is taken from the Pakistan Demographic and Health Survey 2017-18. A weighted sample size of 6803 is selected from the source and analyzed subsequently to produce the desired results. The dependent variable is Uptake of Skilled birth attendance which in dichotomous in nature i.e., Skilled attendance and Unskilled attendance. Explanatory variables at individual level include Employment status of women, Educational level of women, Wealth status, Exposure to Media, Means of transport, Women autonomy to decide and Birth order. Community level variables comprises of Community female literacy level, Community poverty level, Community perception of distance to health facility and Place of residence. For statistical analysis Mixed effect logistic regression is used. The results of this study indicate that the percentage of unskilled birth attendance is 28% and skilled attendance is 72% in the case of Pakistan. The individual level factor such as Birth order, Wealth status, Educational level, exposure to media and women autonomy to decide show statistically significant impact on the uptake of Skilled Birth Attendance. Similarly contextual factors such as Community perception of distance to health facility as a problem and Community literacy level reflect significant influence v on the odds SBA uptake at the time of delivery. The ICC score (54%) calculated in the random effect part of the analysis confirms the influence of contextual factors and buttress the application of multilevel analysis technique. The utilization of skilled birth attendance services during delivery is influenced by both the individual and contextual factors. Public health policies should be designed by considering individual as well as community level associates to increase the uptake of Skilled Birth Attendance in Pakistan Supervisor:- Dr. Rizwan Ul Haq
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