Wealth and Healthcare can Save Pregnant Women
Study of the Effects of Wealth and Access to Healthcare on the Pregnancy and Delivery Process for Yemeni Woman
Map of Yemen
Top Left: Haid Al-Jazil, Top Right: Sana'a, Bottom: Ibb
Background Information
Yemen, a Middle Eastern country on the Arabian Peninsula, is home to over 30 million people, including 15 million Yemeni women. Nearly 65% of the population reside in rural areas, away from densely populated cities. As the population of Yemen is rapidly increasing (by 58% since 1994), a majority of the population is under the age of 30 (Burrowes, 2021).
In 2012-2013, The Yemen National Health and Demographic Survey used cluster sampling to survey nearly 25,000 Yemeni Households from all 20 governorates of the Republic of Yemen. Through these surveys, the Ministry of Public Health and Population, or MOPHP, examined public health and welfare issues in Yemen. While being considered one of the poorest countries in the Middle East and North Africa, the GDP per capita was roughly $1,343 in 2013. Approximately 54% of the population lives in poverty, making less than $2 dollars a day. In the National Health and Demographic Survey, each wealth quintile consisted of 20% of the surveyed households, around 57% of Yemeni households in rural areas fall in the lowest two wealth quintiles but 90% of whereas urban residents fall in the two highest wealth quintiles (Yemen National Health and Demographic Survey 2015:1-13). According to The World Bank, the cost of healthcare is the “single most important reason” that poorer families do not seek care when they are ill. Overall, the poor spend less of their money on health care than the non-poor (“Poverty in Yemen”, 2010).
Overview
With the use of the Yemen National Health and Demographic Survey 2013, I’ve attempted to understand the effects of wealth and access to healthcare on Yemen maternal complications. Responses from around 10,000 women, aged 15-49, who had a child between 2009-2013 were utilized for this project. The data collected focused on complications from the most recent pregnancy and delivery process. Outcome variables were separated into two different categories: Pregnancy Complications and Delivery Complications.
Health Outcomes for Yemeni Women
Dependent Variables
To analyze whether or not healthcare was utilized during pregnancy/delivery, women were asked if they received antenatal care. If so, the surveyor continued by asking what types of care they received and how many times they visited the facility. The components of antenatal care included taking blood and urine samples, recording blood pressure, and taking iron supplements. All women were asked about the types of barriers they faced that prevented them or made it difficult for them to receive healthcare. These barriers include permission to receive care (from spouse or family member), lack of money to afford care, distance from the health facility, going alone to a healthcare provider, or no female physician to provide care. Independent variables used were separated into four different categories: Wealth, Barriers to Healthcare, Antenatal care, and Components of Antenatal Care.
Independent Variables
With the data collected from the survey, I used a logistic regression analysis to examine the association between each independent variable and a given outcome. Bar graphs and visual representations of logistic regressions present the significance and the effects of wealth and access to healthcare on maternal complications. The following sections will display findings from the research.
Pregnancy Complications
Wealth
Number of Women Observed: ~10,112
- Variables that Show Significance with Wealth: All Pregnancy Complications
- Richest quintile: 43-53% less likely to experience pregnancy complications
- Rich quintile: 33-42% less likely to experience pregnancy complications
- Middle quintile: 28-37% less likely to experience pregnancy complications
- Poorer quintile: 19-26% less likely to experience pregnancy complications
Barrier to Healthcare: Permission
- Women were 19% more likely to experience frequent headaches and 16% more likely to experience Swelling/Edema during their pregnancy if getting permission was a barrier to health care
Barrier to Healthcare: Money
- Lack of money to afford healthcare resulted in a 34% increase in the likelihood of experiencing high blood pressure during pregnancy.
Barrier to Healthcare: Going Alone
- Going alone as a barrier to healthcare decreased the likelihood of women experiencing high blood blood pressure
Barrier to Healthcare: Distance
- No significance between distance to a health facility and any of the pregnancy complications.
Barrier to Healthcare: No Female Doctor- No significance between no female doctor and any of the pregnancy complications.
Received Prenatal Care
- Women that received prenatal care were 48% more likely to experience convulsions, 26% more likely to experience headaches, and 36% more likely to experience swelling/edema.
Visited Facility within the past 12 months- Women that visited a health facility within a year before taking the survey were 24% more likely to experience headaches during their pregnancy.
Blood Pressure Taken- Women that got their blood pressure taken during their prenatal care were 138% more likely to experience high blood pressure during their pregnancy.
Urine Sample Taken
- Getting a blood or urine sample taken showed no significance with any pregnancy complications.
Blood Sample Taken
- Getting a blood or urine sample taken showed no significance with any pregnancy complications.
Iron Tablets Taken
- Women that took iron tablets/syrup were 38% more likely to experience convulsions, 17% more likely to experience headaches, and 21% more likely to experience swelling/edema.
Logistical Regression Visual for Each Pregnancy Complication
This visual demonstrates that women who got their blood pressure taken or noted money as a barrier to healthcare were more likely to experience high blood pressure during their pregnancy. Although all wealth quintiles were negatively correlated with high blood pressure, respondents of the higher quintiles were less likely to experience high blood pressure than the lower quintiles.
Respondents in the richest, richer, and middle quintiles were less likely to experience convulsions than respondents in the poorer quintiles. Receiving prenatal care and taking iron tablets during pregnancy were positively correlated with experiencing convulsions.
Similar to experiencing high blood pressure, respondents of all wealth quantities were negatively correlated with experiencing headaches, yet respondents of the higher quintile were less likely to experience high blood pressure than the lower quintiles. Lack of money for healthcare increased the likelihood of experiencing headaches. Additionally, receiving prenatal care and taking iron tablets/syrup resulted in a 19-21% increase in experiencing headaches.
All wealth quintiles were negatively correlated with swelling/edema, but respondents of the higher three quintiles were less likely to experience swelling/edema than the lower quintile. Permission as a barrier to healthcare resulted in a 16% increase in experiencing swelling/edema. Lastly, receiving prenatal care and taking iron tablets/syrup increased the chances of experiencing swelling/edema by 36% and 21% respectively.
Delivery Complications
Wealth
Number of Women Observed: ~10,085
- Variables that Show Significance with Wealth: High Fever, Convulsions, and Excessive Bleeding
- Variables that DO NOT Show Significance with Wealth: Prolonged Labor
- Richest Quintile is 77% less likely to experience High Fever, 53% less likely to experience convulsions, and 48% less likely to experience Excessive bleeding during delivery
- Rich Quintile is 65% less likely to experience high fever, 46% less likely to experience convulsions, 45% less likely to experience excessive bleeding during delivery.
- Middle Quintile is 51% less likely to experience high fever, 20% less likely to experience convulsions, 28% less likely to experience excessive bleeding during delivery.
- Poorer Quintile is 30% less likely to experience high fever during delivery
Barriers to Healthcare: Permission
- Women were 18% more likely to experience high fever, and 13% more likely to experience Excessive Bleeding, and 22% likely to experience prolonged labor during their delivery if getting permission was a barrier to healthcare.
Barries to Healthcare: Money
- Women were 22% more likely to experience high fever and 17% more likely to experience Prolonged Labor if getting money was a barrier to healthcare.
Barriers of Healthcare: Going Alone
- Women were 30% more likely to experience high fever and 29% more likely to experience convulsions if getting going alone was a barrier to healthcare.
Barriers to Healthcare: No Female Doctors
- Women were 16% more likely to experience prolonged labor if having no female providers was a barrier to healthcare.
Barriers to Healthcare: Distance
- There was no significant relationship found between distance as a barrier to healthcare and any delivery complication
Received Prenatal Care
- Women were 25% more likely to experience high fever, 27% more likely to experience excessive bleeding, and 47% more likely to experience prolonged labor if they received prenatal care.
Visited Health Facility within past 12 months
- Women were 21% less likely to experience prolonged labor if they visited a health facility within the 12 months prior to taking the survey.
Blood Pressure Taken
- Women were 30% less likely to experience convulsions and 22% less likely to experience prolonged labor if their blood pressure was taken.
Iron Tablets Taken
- Women that took iron supplements ere 47% more likely to experience convulsions.
Urine Sample Taken
- Getting a blood or urine sample taken showed no significance with any delivery complications.
Blood Sample Taken
- Getting a blood or urine sample taken showed no significance with any delivery complications.
Logistical Regression Visual for Each Delivery Complication
All wealth quintiles were negatively correlated with convulsions during delivery, but respondents of the higher three quintiles were less likely to experience this complication than the lower quintile. Permission, money, and going alone as a barrier to healthcare increased the chances of experiencing a high fever by 18%, 22%, 30% respectively. Lastly, receiving antenatal care also increased the likelihood of experiencing this complication by 25%
All wealth quintiles were negatively correlated with convulsions during delivery, but respondents of the higher three quintiles were less likely to experience this complication than the lower quintile. Going alone increased the possibility of experiencing convulsions by 50%, yet getting blood pressure taken and consistently taking iron tables/syrup were negatively correlated with experiencing convulsions during pregnancy.
All wealth quintiles were negatively correlated with excessive bleeding, but respondents of the higher three quintiles were less likely to experience this complication than the lower quintile. Permission as a barrier to healthcare and receiving prenatal care increased the chances of experiencing excessive bleeding by 13% and 37% respectively.
Respondents in the richest, richer, and middle quintiles were less likely to experience convulsions than respondents in the poorer quintiles. Permission, money, and no female provider all increased the likelihood of having prolonged labor. Receiving prenatal care increased the likely hood of having prenatal care by 52%.
Discussion
Although most wealth quintiles were negatively correlated with each pregnancy and delivery complication, respondents from poor households were more likely to experience complications than those from non-poor households. Having high blood pressure during pregnancy and high fever during delivery were statistically significant with money being a barrier to healthcare. Each complication being positively correlated with this particular barrier indicates that lack of money for healthcare increased the likelihood of experiencing these health issues.
The following complications were statistically significant and positively correlated with receiving antenatal care: Headaches, swelling/edema, high fever, excessive bleeding, prolonged labor, and convulsions (during pregnancy). Receiving antenatal care enabled doctors to identify and/or treat health complications that would have otherwise gone unnoticed. It is likely that the positive correlation between these variables is a result of doctors detecting or women experiencing these complications, therefore they are more likely to seek treatment/tests for it.
There were no major patterns involving the components of antenatal care and any complication/outcome.
Limitations:
Although the logistic regression used for this project helped examine the probability of a complication occurring as a result of wealth status and/or healthcare provided, it does not determine the exact causes of these complications. Other contributing factors such as genetic predisposition, past health history, and current living conditions were not accounted for.
References
Around Yemen. Wandering in Yemen. (2013, September 3). https://alshamahi.wordpress.com/around-yemen/ .
Burrowes, R. (2021, March 10). Yemen. Encyclopædia Britannica. https://www.britannica.com/place/Yemen .
Forbes Magazine. (2018). Yemen. Forbes. https://www.forbes.com/places/yemen/?sh=781f634e76af .
Laurinavicius, R. (1966, January 1). This Village In Yemen Looks Straight Out Of Lord Of The Rings. Bored Panda. https://www.boredpanda.com/mountain-village-haid-al-jazil-yemen/?utm_source=google&utm_medium=organic&utm_campaign=organic .
Poverty in Yemen. World Bank. (2010). https://www.worldbank.org/en/news/feature/2010/01/20/poverty-in-yemen .
Yemen National Health and Demographic Survey 2013. (2015).
5 shocking facts about poverty in Yemen. (2018, January 11). https://borgenproject.org/5-facts-poverty-yemen/#:~:text=Yemen's%20population%20stands%20at%2025.4,than%202%20dollars%20per%20day.&text=Approximately%2045%25%20of%20the%20population%20is%20malnourished .
