Maternal and child health and family planning service utilization in Guatemala: implications for service integration

• Published in: Social science & medicine (1982) 2005-07, Vol.61 (2), p.279-291
• Main Authors: Seiber, Eric E., Hotchkiss, David R., Rous, Jeffrey J., Berruti, Andrés A.
• Format: Article
• Language: English
• Subjects: Access to health care; Adolescent; Adult; Biological and medical sciences; Birth Control; Child; Child care; Child health; Children & youth; Contraception; Contraceptive Agents, Female; Contraceptives; Contraceptives MCH Guatemala Family planning; Delivery of Health Care, Integrated - organization & administration; Family Planning; Family Planning Services - organization & administration; Family Planning Services - utilization; Female; Guatemala; Health; Health Care Utilization; Health services utilization; Humans; Likelihood Functions; Maternal health care; Maternal-Child Health Centers - organization & administration; Maternal-Child Health Centers - utilization; MCH; Medical sciences; Middle Aged; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Service integration; Social sciences; Users; Women's health; Womens Health Care
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2004.11.068

Does the utilization of modern maternal and child health (MCH) services influence subsequent contraceptive use? The answer to this question holds important implications for proposals which advocate MCH and family planning service integration. This study uses data from the 1995/6 Guatemalan Demographic Health Survey and its 1997 Providers Census to test the influence of MCH service utilization on individual contraceptive use decisions. We use a full-information maximum likelihood regression model to control for unobserved heterogeneity. This model produces estimates of the MCH effect, independent of individual women's underlying receptiveness to MCH and contraceptive messages. The results of the analysis indicate that the intensity of MCH service use is indeed positively associated with subsequent contraceptive use among Guatemalan women, even after controlling for observed and unobserved individual- , household- , and community-level factors. Importantly, this finding holds even after controlling for the unobserved factors that ‘predispose’ some women to use both types of services. Simulations reveal that, for these Guatemalan women, key determinants such as age and primary schooling work indirectly through MCH service use to increase contraceptive utilization.