Graduate Program

Economics

Degree Name

Master of Arts (MA)

Semester of Degree Completion

Fall 2019

Thesis Director

Mukti P. Upadhyay

Thesis Committee Member

Ali R. Moshtagh

Thesis Committee Member

Linda S. Ghent

Abstract

The percentage of women utilizing maternal health care services in Nepal is relatively less than women in other South Asian countries. Moreover, large socio-economic and regional disparities have been the root causes for lower utilization of health care leading to increasing maternal mortality. Using a national representative sample of 9,475 women (2011) and 9,875 women (2016) from Nepal, I examine the impact of women empowerment in relation to prenatal care, place of delivery and postnatal care (3Ps) outcomes. A composite Women’s Empowerment Index (WEI) based upon responses is also constructed to include three empowerment domains namely, attitude toward violence, social independence, and decision-making. Control variables explaining socio-demographic and economic factors are also added to the index. Principal Component Analysis (PCA) technique is used to calculate empowerment indicators and regression results are evaluated to estimate the 3Ps. Poisson regression model is used for selected survey years of each of the countries to examine the associations between women’s empowerment and prenatal care visits controlling for other variables. Further, ordered probit model and probit model techniques are used to study the associations of women’s empowerment with place of delivery and postnatal care respectively.

Findings show that a large proportion of pregnant women have at least one ANC exposure but Nepal’s average ANC coverage was 6 visits in 2011 and 7 visits in 2016, indicating that Nepal crosses the global benchmark for the minimum 4 ANC visits. Further, the trend toward significantly greater use of public health institutions is apparent with respect to several other variables. We observe much smaller effects for who makes decisions about household purchases, about woman’s health, and about her family visits. Also, relatively low incidence of postnatal visits to health care institutions was observed in the analysis. Summarizing the categories of women’s empowerment indicators in terms of linear combinations represented conveniently by a single principal component in each of the three cases, we find decision-making and independence factors to be significantly associated with postnatal visits whereas the violence factors to be insignificant in 2011 and barely significant in 2016.

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