an analysis of women's education and economic status in healthcare use during pregnancy

during the past decade there has been an unceasing trend to reduce child and maternal mortality rate, and thus a demand to examine and address the existing challenges. despite the importance of consistent healthcare during pregnancy, childbirth and postpartum period, some iranian women are not currently using these types of services. therefore, the study on the important parameters that can lead to lack of enthusiasm and inclination to use healthcare services is significant. the data for the study is drawn from iran dhs-type survey conducted in 2000 by the ministry of health and medical education of iran. a total of 114,000 households with a total population of about 537,000 are representatively selected from rural and urban areas of 28 provinces, plus an additional sample from the capital city of tehran. data analysis involves a use of logistic regression to predict the probability of healthcare use based on independent variables. the conceptual framework of the study is based on anderson’s social model of healthcare use. independent variables are demographic variables including age, birth, residence, experience of abortion and stillbirth as well as socio-economic variables including education, employment, economic indicator and health condition in household. the study indicates that around 8.6 percent of the total pregnant women of the study do not use any healthcare services. the proportion of not using healthcare services is 6% and 12% in urban and rural areas respectively. in terms of frequency of referral and quality of cares, there exist large differences between urban and rural centers as well. considering the economic index, the difference is however much greater. in the group with low economic status, 30% of women have not referred to any healthcare center to get reproductive healthcares. this figure decreases to 4.5% for those with high economic status. in terms of education, 25% of illiterate people have not referred to any healthcare center. the ratio of not using healthcare among literate women with elementary and high school education decreases to 6.5% and 2% respectively. the study indicates that the economic index has a significant influence on healthcare use. meanwhile, the odds ratio for those with medium and high economic status is 3.1 and 9.25 respectively as compared to 1 in low economic status. thus, education is more influential among independent variables. as the illiterate women are considered as reference group, the odds ratio for women with elementary, high school and university education is 4.8, 27 and 56 respectively. in terms of demographic variables the birth order is a very effective variable. with more children, the probability of using healthcare services becomes less. it is also found that the maternal healthcare use is related inversely to age. the higher the age of respondents is, the lower the probability of healthcare use will be. considering the population of pregnant women in iran, this percentage includes a high number of women who do not use reproductive healthcare services. however, for the number of women interested in using such healthcares, a significant proportion complain about the poor quality and quantity of the offered services. as the study indicates, education and knowledge about contraception has the most stable effect in the models which indicate the significance of ideational factors in reproductive healthcare use. the economic status is of second importance in predicting the use of healthcares.