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Health Policy and Planning Advance Access published online on August 29, 2008
Health Policy and Planning, doi:10.1093/heapol/czn032
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2008; all rights reserved.

Modelling prenatal health care utilization in Tajikistan using a two-stage approach: implications for policy and research

Nazim N Habibov1,* and Lida Fan2

1School of Social Work, University of Windsor, Windsor, Ontario, Canada.
2School of Social Work, Lakehead University, Thunder Bay, Ontario, Canada. E-mail: lfan{at}ucalgary.ca

* Corresponding author. School of Social Work, University of Windsor, Room 2164 Chrysler Hall North, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada. E-mail: nnh{at}uwindsor.ca

Since the transition from a centrally planned to a market economy, Tajikistan has witnessed a high rate of child and maternal mortality, a decline in the birth rate and a significant drop in public expenditures on health care. Against this backdrop, this paper analyses the determinants of prenatal health care utilization using Andersen's behavioural model, which has been modified to the context of Tajikistan. We applied a two-stage sequential model to data drawn from a nationally representative survey. Binary logit regression is used to predict and explain the probability of using prenatal health care services, while negative binomial regression is used to predict and explain the frequency of using these services. Findings suggest that higher educational attainment increases the utilization of prenatal care. Conversely, poverty, limited knowledge about matters related to sex, low quality of health care service, lack of public infrastructure, as well as absence of or long distance of travel to the nearest health facility, all reduce the utilization of prenatal health care. Health policy and research implications are presented and discussed.

Key Words: Two-part model, reproductive health, maternal care, family planning, Central Asia, Tajikistan

Accepted for publication 12 May 2008.


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