Social networks, bargaining power within couples, and maternal health care in Tanzania

Doctoral Thesis


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University of Cape Town

This thesis focuses on the use of maternal health services and child health in Tanzania. The main focus is on how these issues relate to social networks and bargaining power within couples. These issues are interrelated and are discussed in three essays. The first essay investigates the impact of information externalities in social networks on the use of antenatal services. Particular emphasis is placed on the extent to which the probability of early antenatal check-up and antenatal completion are affected by social networks. Adopting an econometric technique that minimises the problem of omitted variable bias, the analysis suggests that these network effects increase the probability of antenatal care completion by an additional 6 to 35 percent, and may be as high as 59 percent. The study further finds that without adequate control of omitted variables, the network impact would be understated. It is also evident that failure to control for individual and household observable characteristics overstates the impact of networks. Results from the two approaches used in this study confirm that irrespective of the definition of social network, having a high quality contacts increase the probability of utilising maternal health services. The second essay examines the effect of bargaining power within couples on the probability of delivering in a health facility (public and private), as opposed to a home birth. It further investigates the effect of bargaining on the probability of health care provider choice at childbirth using a multinomial nested logit. Evidence suggests that cooperation within couples in decision-making, female discretion over household resources, and freedom from domestic violence increases the probability of childbirth in a facility, as opposed to home. The study finds that a woman's influence on service use varies if she is better educated than her partner. In addition, while cooperation in household decision and the incidence of domestic violence significantly affect private facility use, female discretion over household resources has a strong effect on public facility choice. Finally, antenatal completion, health knowledge, and maternal specific factors increase the probability of delivering in a public and private facility. ii The third essay empirically explores the contribution of intra-household bargaining, to the rural-urban gap in child nutrition. The study analyses the effect of parental bargaining indicators (cooperation in household decisions, the incidence domestic violence and discretion over household resources) on the probability of child stunting in both rural and urban areas. The essay contributes to the literature by demonstrating empirically that differences in intra-household bargaining increase the rural-urban gap in child health. It further contributes to the literature by correcting for possible sample selection bias. The results suggest that the significant effects of household bargaining indicators on child stunting in Tanzania are mainly from the rural and not the urban population. It provides evidence that weak bargaining power within couples in rural areas account for 5 percent of the rural-urban gap in child nutrition. The contribution reduces to 4 percent after correcting for sample selection bias. The results also suggest that failure to adequately correct for selection bias leads to a substantial underestimation of the overall rural-urban gap in child nutrition by 11 percent.

Includes bibliographical references