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Open AccessArticle

Understanding Barriers and Facilitators of Maternal Health Care Utilization in Central Myanmar

Global Environmental Health LAB, Brooklyn, NY 11026, USA
Department of International Relation, Yadanabon University, Mandalay 05063, Myanmar
Department of Geography, Meiktila University, Meiktila 05181, Myanmar
Department of Geography, Mandalar Degree College, Mandalay 05052, Myanmar
Department, of Applied Economics, Meiktila University of Economics, Meiktila 05181, Myanmar
Department of Economics, Mandalay University, Mandalay 05032, Myanmar
Mandalay City Development Committee, Mandalay 100102, Myanmar
Department of Preventive and Social Medicine, University of Medicine, Mandalay 05024, Myanmar
Department of Health Policy and Management, University of California, Los Angeles, CA 90095, USA
Yale Center for Analytical Sciences, Yale University, New Haven, CT 06511, USA
Public Health Program, Northern Illinois University, Dekalb, IL 60115, USA
Center for Southeast Asian Studies, Northern Illinois University, Dekalb, IL 60115, USA
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(5), 1464;
Received: 29 January 2020 / Revised: 21 February 2020 / Accepted: 21 February 2020 / Published: 25 February 2020
The study objective was to examine barriers and facilitators of maternal health services utilization in Myanmar with the highest maternal mortality ratio in Southeast Asia. Data for 258 mothers with children under five were extracted from a community health survey administered between 2016 and 2017 in Mandalay, the largest city in central Myanmar, and analyzed for associations between determinants of maternal health care choices and related outcomes. The study showed that late antenatal care was underutilized (41.7%), and antenatal care attendance was significantly associated with geographical setting, household income, education, and access to transportation (p ≤ 0.05). Less than one-third of women gave birth at home and 18.5% of them did so without the assistance of traditional birth attendants. Household education level was a significant predictor for home delivery (p < 0.01). Utilization of postnatal care services was irregular (47.9%–70.9%) and strongly associated with women’s places of delivery (p < 0.01). Efforts geared towards improving maternal health outcomes should focus on supporting traditional birth attendants in their role of facilitating high-quality care and helping women reach traditional health facilities, as well as on maternal health literacy based on culturally appropriate communication. View Full-Text
Keywords: maternal health; health care utilization; Myanmar maternal health; health care utilization; Myanmar
MDPI and ACS Style

Milkowska-Shibata, M.A.; Aye, T.T.; Yi, S.M.; Oo, K.T.; Khaing, K.; Than, M.; Win, T.; Myo, S.Y.; Toe, S.Y.; West, H.S.; Ringstad, K.M.; Galarza, L.; Meng, C.; Shibata, T. Understanding Barriers and Facilitators of Maternal Health Care Utilization in Central Myanmar. Int. J. Environ. Res. Public Health 2020, 17, 1464.

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