Access to Health Facility and Frequency of Antenatal Care Visits in Malawi Using Bivariate Copula Regression Modelling

Access and use of antenatal care (ANC) are among the identified interventions to reduce maternal and neonatal mortality. However, access and frequency of ANC visits are inter-related. Quantifying dependencies and shared determinants among inter-related variables are crucial to avoid erroneous conclusions and misinformed policy interventions. This study fitted a bivariate copula-based regression to jointly model access to health facility (measured using distance) and frequency of ANC use in Malawi, using a sample of 9228 reproductive-age women, from the 2015/16 Demographic and Health Survey. Results indicate that access to health facility significantly varied by region and place of residence. Both age and listening to the radio at least once a week were related to access to Health Facility (HF). Findings also show that frequency of ANC was associated with the women’s education level, age, employment status, wealth index, if ever wanted the pregnancy, and listening to radio. In conclusion, this study confirms that women with more ANC visits are more likely to have a HF close to their location as compared to those who have fewer ANC visits. Increased access to health facility, through mobile clinics, and initiating ANC early should be an important policy intervention for improved maternal and neonatal health.