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This paper is one of the Further Analysis Reports that use data from the Demographic and Health Surveys conducted in Mali. This report is based exclusively on the 2018 survey. The research question is whether healthcare seeking, by women age 15-49 and on behalf of children age 0-4, varies according to aspects of household structure.
Three indicators of healthcare seeking behaviour are used for women and three for children. The indicators for women include whether (1) the woman has had an HIV test; (2) she had four or more antenatal care visits for her most recent birth, and (3) her most recent birth was in a facility. The indicators for children include whether (1) the child received postnatal care, (2) the child was taken for treatment if the child had diarrhoea in the past 2 weeks, and (3) the child was taken for treatment if the child had a fever in the past 2 weeks.
Several indicators of household structure are included. The first is a simple distinction between nuclear and extended households. By definition, a nuclear household consists solely of persons who are classified as the head, spouse of head, or child of head. A household that includes any de jure members with a different relationship to the head is an extended household. About one-third of households in the 2018 survey are extended. Such households are more common in urban rather than rural areas. About 26% of children in rural areas and about 47% of children in urban areas live in an extended household. For women, the percentages are 33% and 54%.
Healthcare seeking tends to be greater in extended households, for both women and children. This effect appears to be due to the presence of more adults in the extended households, who are able to substitute for one another with child care and other responsibilities when a woman is temporarily away from home for her own healthcare or that of a child.
Three indicators of the household head are included: sex, age (in broad categories), and education. Since the proportion of adults with secondary or more schooling is small in Mali, the schooling indicator is simply if the head has some schooling at any level, or does not. The most pronounced effect is related to this indicator. If the household head has any schooling, healthcare seeking tends to be greater than if the head has no schooling. The age of the head is beneficial for age 45 and over, compared to younger ages. A male household head is beneficial for most outcomes, but not for all.
The third indicator of household structure is the relationship of the woman or child to the head. For most outcomes, the beneficial effect of an extended household extends to all women and children, regardless of whether they are the spouse or child of the head.
The report also examines the potential effect of three standard indicators of women’s empowerment—whether a woman makes decisions alone (or together with her spouse) or lacks the power to do so—for seeking healthcare, making major purchases, or visiting friends or relatives. The third has the strongest evidence of a relationship, although in a multivariate analysis with statistical controls, none of the three is statistically significant. These indicators were not applied to healthcare seeking for children, because we do not know specifically who in the household takes a child for treatment for diarrhoea or fever.
Perhaps the most striking findings in the report are that the women and children in a household are benefitted if the head has had any schooling, even just primary; and that healthcare seeking appears to be more likely if the household is extended and includes members who can substitute for a woman when she temporarily leaves the household for her own healthcare or for a sick child.