Predictors of antenatal health service utilization among left-behind wives of male outmigrants: Evidence from Patna District, India

Objective: To analyze the sociological support system available for left-behind wives of male outmigrants and develop a model that predicts the antenatal care (ANC) services utilization. Methods: A cross-sectional survey was conducted in rural regions of the Patna district, India. The sample size (n=328) was estimated using Cochran's formula. Five parameters of the social support system were identified (autonomy, spousal support, family support, social circle support, and government support). The score for each was calculated as a composite score using multiple variables; these served as independent variables. The respondents were categorized as efficient and non-efficient users of ANC service based on established criteria. Results: The regression results showed that four out of five social parameters had a significant effect on ANC behavior. Spousal support was the strongest predictor (standardized regression coefficient beta=0.57, OR 1.16, 95% CI 1.08-1.79, P=0.007). Government support was found to be the second strongest predictor (beta=0.40, OR 1.49, 95% CI 1.04-2.14, P=0.027), followed by family support (beta=0.31, OR 1.36, 95% CI 1.23-2.57, P=0.034) and autonomy (beta=0.11, OR 1.32, 95% CI 1.11-2.26, P=0.030). The social circle support was found to be non-significant in predicting ANC behavior (P>0.05). Conclusions: The policymakers could focus on the identified predictors to strengthen and modify the existing policies for left-behind wives of male outmigrants. The need of the hour is a strategic intervention for behavioral modification of not only the left-behind wives but also their family members along with reinforcement of the existing social-security net. One strategy we suggest is to launch an awareness campaign focusing on husbands (male outmigrants) and family members.