Utilization of formal services for maternal nutrition and health care in the Third World

While studies indicate that an overwhelming majority of these cases could be prevented through proper care, in fact less than a third of pregnant women in the developing world receive any formal prenatal care. This paper reviews relevant economic, sociological, and anthropological studies to identify factors constraining utilization of formal maternal nutrition and health care services. Service-related factors such as physical distance, hours of availability, and transportation difficulties, together with long waiting times and inadequate supplies, emerged repeatedly as key constraints. These problems are frequently exacerbated by the poor technical and interpersonal skills of the maternal care providers and widespread corruption within the formal health system. The main user-related factor appears to be the demands on women"s time. Emergencies apart, women use formal childbirth services far less than they do formal prenatal services, due to conditions specific to the childbirth experience -- the availability of family support and care, the need for privacy and emotional support (provided traditionally by female birth attendants), higher costs, and the difficulty of traveling. The latter difficulty was also a major reason why use of maternal care differs from use of general health care. Recommendations for further research are presented.