Does owning a bank account improve reproductive and maternal health services utilization and behavior in India? Evidence from the National Family Health Survey 2015-16

Mitigating role of financial inclusion on the perceived difficulties, concerns, and borrowing for medical expenses in Saudi Arabia

Access to convenient quality healthcare at all times is considered a basic human right; however, many countries are still striving to achieve this goal for their populations. The persistent rise in healthcare expenditure remains a significant obstacle in achieving universal health coverage on a global scale. The aim of this study was to investigate the role of financial inclusion in addressing the financial hardship related to health and medical expense concerns in the Kingdom of Saudi Arabia. Probit models were applied to analyse nationally representative data from the Global Financial Inclusion (Global Findex) database. The results showed that financial inclusion had a significant impact on reducing the hardship associated with obtaining money for emergency expenses within 30 days as indicated by a significant coefficient of -0.262. Additionally, Financial inclusion substantially increases the likelihood of borrowing money for health or medical purposes in the past 12 months, with a coefficient of 0.585. Moreover, correlations were identified between low income levels and decreased likelihood of borrowing for health/medical purposes, increased difficulty in obtaining money for emergency expenses, and heightened concern regarding the ability to afford medical costs in the event of serious illness or accidents. These findings highlight the need for policy makers and health providers to prioritize financial inclusion and support programs for low-income individuals to achieve equity in health treatment for all in Saudi Arabia.

Is Financial Capability a Determinant of Health? Theory and Evidence

Financial capability, the combination of financial literacy (ability to act) and financial access (opportunity to act), improves people's access to resources, and thus has the potential to improve health and well-being. This paper positions financial capability under the framework of social determinants of health and discusses theory and presents empirical evidence on the link between financial capability and health. Using data from the RAND American Life Panel and the structural equation modeling approach, we distinguish financial capability from the common socioeconomic position indicators such as income and education. We find that financial capability has a positive and longitudinal effect on health, independent of race/ethnicity, gender, income, education, and employment. This study demonstrates that financial capability is an independent social determinant of health. It can be theoretically and conceptually defined, empirically measured, and can inform clinical interventions that may improve population health and well-being. Implications for future research, practice, and policy are discussed.

Associations of financial inclusion with physical activity participation in later life

Background

Physical activity (PA) is a vital modifiable psychosocial intervention for promoting healthy longevity but problematically decreases with age. Innovative community-based strategies are recommended by the World Health Organization (WHO) to improve PA but prior research has seldom considered the interactive effect of financial inclusion, social networks, and sex differences on PA. In this study, we examine the role of sex differences and resourceful social networks in relation to the association of financial inclusion with PA among older Ghanaian people.

Methods

The sample included 1201 adults aged ≥50 years who participated in the 2016-17 AgeHeaPsyWel-HeaSeeB study. We assessed financial inclusion with an eight-item Financial Instrument Questionnaire Scale and PA with the International Physical Activity Questionnaire Short Form (IPAQ-SF). Linear regressions and moderation analysis were used to test the hypothesized associations.

Results

The mean financial inclusion and PA scores were 1.9(±1.8) and 9.0(±4.4) respectively. After full adjustment for potential confounders, a unit increase in financial inclusion was significantly and positively associated with increases in PA participation (β = .308, p < .005) and also notable among those aged ≥65 years (β = .413, p = .023). Crucially, the positive association between financial inclusion and PA was significantly modified by social networks (β = .151, p < .001). However, the role of sex in this association was not robust.

Conclusions

Findings emphasize the effect of financial inclusion on PA in old age, particularly when considering social networks. Programs to improve financial inclusion and social integration may benefit the acceptance and participation of PA among older adults.

Does financial inclusion predict a lower risk of loneliness in later life? Evidence from the AgeHeaPsyWel-HeaSeeB study 2016-2017

OBJECTIVE

For many older people, loneliness represents a common source of impaired quality of life particularly in the context of poor access to financial services. This article examines the association between financial inclusion and loneliness in older adults and explores the moderating effects of gender and physical activity in this association.

METHODS

One thousand two-hundred participants completed the Short Form Revised UCLA Loneliness Scale assessing loneliness during 2016-2017 Aging, Health, Psychological Well-being and Health-seeking Behavior (AgeHeaPsyWel-HeaSeeB) Study. Financial inclusion was assessed using an 8-item Financial Instrument Scale.

RESULTS

Multiple ordinary least squares (OLS) regressions showed that increases in financial inclusion were associated with decreases in loneliness in the total sample (β = -0.679, p < 0.001) and in women (β = -0.787, p < 0.001) but not in men (β = -0.594, p = 0.084). The negative effect of financial inclusion on loneliness was pronounced among those who engaged in physical activity (β = -0.646, p < 0.042).

CONCLUSIONS

Findings underscore the importance of financial inclusion for loneliness in later life particularly among older women and those who engage in physical activity. Encouraging and strengthening financial inclusion may crucially improve psychological health and emotional well-being among aging adults.

Treatment and rehabilitation of stroke patients in India: A gendered analysis based on repeated cross-sectional national sample surveys on health, 2014 and 2019

We attempt a gendered inspection of sex differentials in care following stroke in India using data from two rounds of NSSO. While almost all men and women receive allopathic care, a higher percentage of women (51.8%) were treated in public hospitals compared to men (32.6%) in 2014 and 2017-18 (45.8% vs 41.4%). Men were preponderantly treated in private hospitals (67.4%) compared to women (48.2%) in 2014 and 2017-18 (58.6% vs 54.2%). We provide evidence that for rehabilitation, at the highest decile for expenditure, men spend more than women. This preliminary exploration is indicative of a gendered dimension in care-seeking for stroke.

Dimensions of women's empowerment on access to skilled delivery services in Nepal

Background

Each day, approximately 810 women die during pregnancy and childbirth and 94% of the deaths take place in low and middle income countries. Only 45% of the births in South Asia are attended by skilled professionals, which is lower than that in other Asian regions. Antenatal and postnatal care received from skilled providers can help prevent maternal and neonatal mortality by identifying pregnancy-related complications. Women’s empowerment is considered to be a significant determinant of maternal health care outcomes; however, studies on the contextual influences of different dimensions of empowerment in Nepal are relatively limited. Therefore, this study analyzed nationwide survey data to examine the influence of women’s economic empowerment, sociocultural empowerment, familial/interpersonal empowerment and media and information technology empowerment on accessing skilled delivery services among the married women in Nepal.

Methods

This study examined the influence of women’s empowerment on skilled delivery services among married women (n = 4400) aged 15–49 years using data from the 2016 Nepal Demographic and Health Survey. Descriptive analysis and binary logistic regression analysis were employed to analyze the data.

Results

Significant associations were found between women’s media and information technology empowerment, economic empowerment and sociocultural empowerment and access to skilled birth attendants. Specifically, the education of women, their occupation, owning a bank account, media exposure, and internet use were significantly associated with the use of skilled birth attendants.

Conclusion

Focusing on women’s access to media and information technology, economic enhancement and education may increase the use of skilled birth attendants in Nepal.

The impact of financial inclusion on mental health

This paper examines the impact of financial inclusion on the mental health of heads of household in Nigeria. The study employed data from the 2015/2016 Nigerian General Household Survey (GHS), matched with georeferenced data concerning financial services obtained from the Insight2Impact (i2i) GIS interface. The results indicate that financial inclusion has a strong positive impact on mental health. The study used a robust instrumental variable method, in which a household's distance from the nearest financial institution was used as the instrument for financial inclusion. In addition, it identified the potential channels through which financial inclusion can influence mental health, including: (1) food expenditure; (2) remittances; and (3) risk-coping mechanisms. The findings of this study reinforce growing evidence for the benefits of financial inclusion for alleviating depression symptoms.

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We study the effect of financial inclusion on mental health of household heads.

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We proxied mental health using the Center of Epidemiologic Studies Short Depression Scale (CES-D 10).

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We construct a multidimensional financial inclusion index using three dimensions of financial inclusion.

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We combine georeferenced data on financial location data points with the Nigerian General Household survey.

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We find that financial inclusion results in improved mental health of household heads.

Mobile Money Use and Healthcare Utilization: Evidence from Rural Uganda

Lack of cash on hand is a significant obstacle in accessing healthcare services in developing countries. Many expectant mothers in the least developed countries do not receive sufficient care during pregnancy due to financial constraints. If such hurdles in accessing healthcare can be overcome, it will contribute to reduction in maternal and newborn mortality, which is a key target of Sustainable Development Goal 3. This study reports the first assessment of the impact of mobile money services on maternal care utilization. We hypothesize that mobile money adoption would motivate rural Ugandan women to receive antenatal care and to deliver their children at health facilities or with skilled birth attendants. By receiving remittances utilizing mobile money, poor rural households may obtain more cash in hand, which might change women’s health-seeking behavior. We apply community- and mother-fixed effects models with heterogeneity analysis to longitudinal panel data (the RePEAT [Research on Poverty, Environment, and Agricultural Technology] survey) of three waves (2009, 2012, and 2015). The analysis uses pregnancy reports of 2007–2015 from 586 rural Ugandan households. We find suggestive evidence that mobile money adoption positively affects the take-up of antenatal care. Heterogeneity analysis indicates that mobile money brings a larger benefit to geographically challenged households by easing their liquidity constraint as they face higher cost of traveling to distant health facilities. The models failed to reject the null hypothesis of no mobile money effect on the delivery-related outcome variables. This study suggests that promoting financial inclusion by means of mobile money motivates women in rural and remote areas to make antenatal care visits while the evidence of such effect is not found for take-up of facility delivery or delivery with skilled birth attendants.

More than credit: Exploring associations between microcredit programs and maternal and reproductive health service utilization in India

Microcredit programs are increasingly popular interventions aimed at enabling women's economic empowerment in low- and middle-income countries. Resultant improved income, and social support from co-members of microcredit programs, may lead to increased utilization of health services. But existing research is inconclusive. This study investigates the association of microcredit program awareness and participation, with maternal and postpartum reproductive health service utilization in India. We use data from a nationally representative survey, the National Family Health Survey (2015-16), and assess three indicators of maternal health service utilization: receipt of four or more antenatal check-ups, institutional delivery, and postnatal check-up among women who had a child less than 5 years of age (N = 32,880). Reproductive health service utilization is assessed via postpartum contraceptive use within 12 months of childbirth, among women who had a live birth in the 12-59 months preceding the survey (N = 24,258). We use binomial and multinomial logistic regression models to examine associations. Additionally, we use propensity score matching to account for self-selection bias. One-third of women are aware of microcredit programs in their community/village, but only 6% have ever taken a loan from these programs. Both microcredit program awareness and participation are associated with higher odds of antenatal care, postnatal check-ups, as well as use of a modern method of contraceptive within 12 months of childbirth, even after accounting for self-selection bias. Stratified analysis by household wealth show that significant associations seen in our primary analyses are significant only for the poorest women. Findings highlight the potential value of microcredit programs in improving health service utilization during and after pregnancy, particularly among poor women. Microcredit program benefits extend beyond their participants. Non-participants living close to the programs also have greater odds of maternal and reproductive health service utilization, suggesting a spillover effect of these programs at the community level.