Does Antenatal Care Matter in the Use of Skilled Birth Attendance in Rural Africa: The Case of Ghana, Kenya, Tanzania and Uganda

Vissého D. Adjiwanou, Université de Montréal
Alain K. Koffi, Johns Hopkins University

While the importance of prenatal care (ANC) on maternal and child mortality continues to be debated, several researchers have documented its effects on mortality intermediate variables. These studies have also highlighted the problems of causality that are not taken into account in estimating the effect of ANC on skilled birth attendance (SBA) in previous work. In this paper, we revisit this relation in rural areas for four countries: Ghana, Kenya, Uganda and Tanzania. Using a structural equation modeling approach that corrects for endogeneity, we find that the usual simpler models (probit) tend to underestimate the direct effect of ANC on SBA. Furthermore, our results show that, in three of the countries, this effect is largely mediated by the quality of services offered to women during ANC. These findings strongly suggest that governments and NGOs should place more importance on the role of the providers and the quality of care offered, in their efforts to promote SBA.