This article explores the hypothesis that formal education of women influences the use of maternal health-care services in Peru, net of the mother's childhood place of residence, household socioeconomic status and access to health-care services. The findings are consistent with the hypothesis; both cross-sectional and fixed-effects logit models yield quantitatively important and statistically reliable estimates of the positive effect of maternal schooling on the use of prenatal care and delivery assistance. In addition, large differentials were found in the utilization of maternal health-care services by place of residence, suggesting that much greater efforts on the part of the government are required if modern maternal health-care services are to reach women in rural areas.
PIP: The hypothesis that maternal education influences use of maternal health care services in Peru was analyzed by 4 logistic regression models, using data from the Peruvian Demographic and Health Survey of September-December 1986. Peru has one of the highest child-mortality rates in the region, with extreme variation across regions of the country, ranging from 34/1000 in Lima to 110/1000 in the Andean mountains. The conceptual framework for this study was the health-seeking model of Kroger who proposed that utilization depends on predisposing factors including education, characteristics of the illness, and of the health-care system. This study analyzed 1925 births, the last births to 4999 ever-married women in the 5 years before the survey. The 2 dependent variables were sources of prenatal care and assistance at delivery. 60.1% of the women had formal prenatal care, and 54.9% had formal delivery assistance for their last birth. The bivariate effects of maternal schooling were strongly associated with use of health care, with relative odds of 47.47 for delivery assistance, and 25.37 for prenatal care. Controlling for the woman's childhood background in Model 2 reduced the odds to 13.6 and 19.69, respectively. In model 3 access to care reduced relative odds to 8.33 for prenatal care and 10.70 for delivery assistance. Taking into account the household socioeconomic status in Model 4 reduced significance of the results. The results indicated that maternal education has a profound effect on seeking medical care, but in Peru the lack of access to care in the outlying rural areas supersedes maternal education.