Comparing Take-up Rates of Prenatal Care in Indonesia and the Philippines

• In Event: Authority & Authorities: The Gendered Dimensions of Policy Implementation

Abstract

What explains variation in the effectiveness of policies designed to improve preventive care for women, such as access to prenatal care? Scholars and policymakers have long debated the merits of decentralized governance as a mode for improving the delivery of goods and services, which takes on particular importance in the context of improving women’s health policies and outcomes. In recent years debates in the global health community have focused on national-level versus individual-level explanations for variations in birth-related women’s health programs. In particular, there has been an emphasis on the shape of and fiscal commitment to national interventions, as well as individual attributes such as education, economic status, and rural/urban residency. Yet, there has been little attention as to whether subnational authority (aka. decentralized government) has an effect on women’s health outcomes, either independently or interdependently of those national and individual factors. I argue that researchers need to broaden their expectations about the impact of subnational authority on women’s health outcomes, especially in comparing the provision of prenatal care within countries. More specifically, I expect that countries with more authoritative regional governments will have greater take-up of long-term preventive care needs, such as the series of practitioner visits recommended during prenatal care. This is because such care needs typically require greater local institutional capacity and infrastructure. However, I also expect that countries with more authoritative regional governments will have greater within-country variance in changes in those take-up rates, particularly when comparing across rural-urban divisions that may exacerbate the level and influence of the privatization of healthcare. I test these assumptions through a comparison in take-up rates of prenatal care in Indonesia and the Philippines between 1992 and 2012. My results indicate that decentralization may help to “close the gap” between traditionally strong urban and traditionally weak rural care provision and access. However, it is clear that widespread healthcare privatization, rather than local public provision, plays a key role in the reduction of the gap.

Author

• Sarah Shair-Rosenfield, Arizona State University