ANTENATAL AND DELIVERY CARE UTILIZATION IN URBAN AND RURAL CONTEXTS IN VIETNAM: A study in two health and demographic surveillance sites

......................................................................................................................... iv LIST OF PAPERS .................................................................................................................. v ABBREVIATIONS ................................................................................................................ vi CONTENT .......................................................................................................................... vii PREFACE .......................................................................................................................... viii 1. BACKGROUND ................................................................................................................ 1 1.1. Maternal and child health ........................................................................................................................................ 1 1.2. Maternal Health care in Vietnam .......................................................................................................................... 5 1.3. Health and Demographic Surveillance Systems ............................................................................................ 7 1.4. The rationale of the research accounted for in this thesis ........................................................................ 8 1.5. Aims of the research .................................................................................................................................................. 9 2. CONTEXT AND STUDY SETTING ..................................................................................... 10 2.1. Vietnam ........................................................................................................................................................................ 10 2.2. The study settings: FilaBavi and DodaLab HDSS ....................................................................................... 16 3. METHODS .................................................................................................................... 18 3.1. Study Design ............................................................................................................................................................... 18 3.2. Data Collection .......................................................................................................................................................... 18 3.3. The Andersen Health Seeking Behavior Model ........................................................................................... 20 3.4. Outcome Variables ................................................................................................................................................... 21 3.5. Explanatory Variables and Associations ........................................................................................................ 23 3.6. Data Analysis .............................................................................................................................................................. 24 3.7. Ethical Considerations ........................................................................................................................................... 25 4. EMPIRICAL RESULTS ..................................................................................................... 26 4.1. Background Information ....................................................................................................................................... 26 4.2. The Use of Antenatal and Delivery Care in Urban and Rural Areas ................................................... 26 4.3. Factors associated with Antenatal and Delivery Care Utilization ....................................................... 31 5. DISCUSSION ................................................................................................................. 36 5.1. Low Adequate Use of Antenatal Care in the Rural Area .......................................................................... 36 5.2. Technology Preference in the Urban Area .................................................................................................... 38 5.3. Role of Socioeconomic Condition in Antenatal and Delivery Care ..................................................... 41 5.4. Other Factors Possibly Associated with Antenatal and Delivery Care Utilization ....................... 43 5.5. Methods and Methodology ................................................................................................................................... 47 6. CONCLUSIONS AND IMPLICATIONS .............................................................................. 51 6.1. Conclusions ................................................................................................................................................................. 51 6.2. Practical Implications ............................................................................................................................................. 51 6.3. Future Research ........................................................................................................................................................ 52 ACKNOWLEDGEMENTS .................................................................................................... 53 REFERENCES ..................................................................................................................... 56