Association between health insurance coverage and four antenatal care utilization in Cambodia: Analysis of Cambodia Demographic and Health Survey 2021-22

Health insurance plays an important role in reducing or eliminating the financial barrier to accessing maternal health services caused by out-of-pocket payments. It has a beneficial effect in minimizing the number of maternal and child mortality. In this study, we examined the association between health insurance coverage and antenatal care (ANC) visits during pregnancy. The study utilized data from the 2021-22 Cambodia Demographic and Health Surveys (CDHS). A total of 3,162 weighted women who gave birth within two years were included in the analysis. Multiple logistic regression analysis assessed the association between health insurance coverage and pregnant women who attended at least four antenatal care visits during pregnancy. About 24.9% of women had any form of health insurance coverage during 2021-22. A great majority (86.1%) of women attended at least 4 ANC visits. Almost 91.6% of women participating in four or more ANC visits were covered by health insurance. Having health insurance and attending four or more ANC visits were statistically significant adjusted odds ratio (AOR = 1.6; 95% CI: 1.1–2.4). Other factors significantly associated with attendance of four or more ANC visits include women with higher education (AOR = 3.1; 95% CI: 1.2–7.7), secondary education (AOR = 2.3; 95% CI: 1.5–3.5), richest households (AOR = 3.2; 95% CI: 1.5-6.8), and richer households (AOR = 1.9;95% CI: 1.2-2.8). Having health insurance coverage was significantly associated with four or more ANC visits. Thus, providing health insurance may be essential to improving women’s access to maternal health services in Cambodia. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used women's data extracted from the most recent CDHS 2021-22, which are publicly available with all personal identifiers of study participants removed. Permission to analyze the data was granted through registering with the DHS program website at (URL: https://dhsprogram.com/data/available-datasets.cfm). Written informed consent was obtained from the parent/guardian of each participant under 18 before data collection. The Cambodia National Ethics Committee for Human Health Research (NECHR) approved the data collection tools and procedures for CHDS 2022 for Health Research on 10 May 2021 (Ref # 83 NECHR) and ICF's Institutional Review Board (IRB) in Rockville, Maryland, USA. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes