Factors associated with use of maternal health services in Haiti: a multilevel analysis.

OBJECTIVE To assess factors associated with utilization of maternal health services (MHS) among women giving birth in Haiti from 2007 - 2012. METHODS Observational data derived from the 2012 Haiti Mortality, Morbidity and Service Use Survey are analyzed. Multilevel analytic methods are used to assess factors associated with use of antenatal services and skilled birth attendance (SBA). RESULTS The strongest adjusted predictors include child's birth rank, household poverty, and community media saturation. The odds of obtaining four antenatal care visits decrease by 53% (odds ratio (OR) = 0.47; 95% confidence interval (CI): 0.37-0.57) with high birth rank and by 37% (OR = 0.63; 95% CI: 0.51-0.78) with household poverty, and increase by 38% (OR = 1.38; 95% CI: 1.01-1.88) with high community media saturation. The odds of using SBA at delivery decrease by 72% (OR = 0.28; 95% CI: 0.22-0.34) with high birth rank and by 42% (OR = 0.58; 95% CI: 0.46-0.73) with household poverty, and increase by 92% (OR = 1.92; 95% CI: 1.41-2.61) with high community media saturation. Use of antenatal services is strongly associated with SBA (OR = 2.20; 95% CI: 1.85-2.61). Significant clustering of use of MHS exists at the community level. CONCLUSIONS Factors associated with use of MHS operate at multiple levels. Efforts to promote such services should identify and pay special attention to the needs of multiparous and uneducated women, address the distance-decay phenomenon, and improve access for the poor. Community mobilization efforts designed to change norms hindering the use of MHS are also relevant.