Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Mayur Desai

Second Advisor

Kaveh Khoshnood


Strategies targeted at decreasing delays in care-seeking behavior and increasing use of skilled birth attendance and health care facility delivery help save maternal and neonatal lives. Counseling women on the danger signs of pregnancy during antenatal care (ANC) visits is one such strategy. This study aimed to examine the effect of pregnancy complication advice on the likelihood of institutional delivery as well as determine the factors that predict higher likelihood of advice receipt. Information from 74,863 mothers who received at least one ANC visit from the most recent Demographic and Health Surveys of 9 South and Southeast Asian countries were analyzed. Multilevel logistic regressions were used to predict the likelihood of advice receipt and institutional delivery, by maternal factors. Less than a quarter of women from Cambodia, Indonesia and Timor Leste while as high as 65.7% from India reported receipt of advice. Less than 25% of pregnancies were delivered at health care facilities in Bangladesh, Cambodia, Indonesia, and Timor Leste and was as high as half in India and Pakistan. Multilevel modeling revealed that mothers with at least a secondary education, primiparas, and those with more antenatal visits were significantly more likely to receive pregnancy advice during antenatal care visits than their counterparts, i.e. teenage mothers, the less educated, multiparas, and those with less ANC visits. There was a null effect of pregnancy complication advice on institutional delivery (OR=0.99). Likelihood of receipt of advice increased with additional ANC visits. Pregnancy complication advice interacts with the number of ANC visits to increase the likelihood of institutional delivery. In order to leverage pregnancy complication advice, quality should be improved with better training of ANC providers and repetition of consistent messaging that is understandable to mothers. Strategies should target mothers with low levels of education, high parity and young mothers to narrow the equity gaps. Beyond this, it is necessary to address the known barriers of delivery costs, transportation issues and cultural beliefs in order to substantially improve maternal and neonatal survival.


This is an Open Access Thesis.

Open Access

This Article is Open Access