Exposure to family planning messages on social media and its association with maternal healthcare services in Mauritania

Abstract

Background

Mauritania, a lower-middle-income country in Northwest Africa, has one of the highest maternal and infant mortality rates worldwide and struggles to ensure optimal use of maternal healthcare services. Raising health awareness through family planning messages can promote maternal healthcare use, potentially reducing preventable maternal and child mortalities. The objective of the study was to assess the potential impact of exposure to family planning messages through social media on the utilization of maternal healthcare services among Mauritanian women.

Methods

Data from the 2019-20 Mauritania Demographic and Health Survey (MDHS) on 7,640 women were analyzed. Multiple logistic regression models were applied to examine the associations between exposure to family planning messages through social media and maternal healthcare services, specifically the timing and adequacy of ANC visits, and facility-based childbirth. Adjusted odds ratios with 95% confidence intervals (CI) were estimated.

Results

The percentage of timely initiation and adequate use of ANC among the participants were 65.6% and 45.1%, respectively. Approximately 75.0% of the women reported giving birth to their last child at a healthcare facility. Exposure to family planning messages on social media was significantly associated with increased odds of receiving adequate antenatal care visits (OR = 1.38, 95% CI = 1.12,1.71) and giving birth in a health facility (OR = 1.83, 95% CI = 1.09,3.08), Other factors such as age, health insurance, wealth, and desired timing of the last child were also found to be important predictors of maternal healthcare.

Conclusion

The findings suggest that exposure to family planning messages on social media is strongly associated with adequate antenatal care and health facility-based childbirth, but not with early timing of antenatal care. Comprehensive maternal healthcare policies should consider the role of social media in promoting family planning messages.

Background

Proper utilization of essential maternal healthcare services such as antenatal care and health facility-based childbirth is crucial for expecting mothers to ensure a healthy pregnancy and avoid potential health risks [1,2,3]. Maternal healthcare services, including antenatal care, health facility-based childbirth and postnatal care are crucial for ensuring the health and well-being of both mother and child [4, 5]. Antenatal care consists of regular medical check-ups that expectant mothers undergo to ensure optimal pregnancy outcomes and reduce potential health risks. This vital component of maternal healthcare helps identify potential complications early, allowing for timely interventions. Studies have shown that attending regular antenatal care is one of the most important steps during pregnancy, as it allows important check-ups with healthcare professionals to monitor the health status of the mother and her fetus [6, 7]. Antenatal visits are also an important resource for women as they bring them into contact with doctors, midwives, and nurses who can provide vital guidance and support to prepare for childbirth, such as place of birth, postnatal care, and childcaring practices like breastfeeding and growth monitoring. These visits offer an important opportunity for women to communicate their health concerns with the medical team, who can check for physical or psychological symptoms.

Using skilled childbirth services ensures that pregnant women receive proper medical attention both during their childbirth and during the postpartum period, which accounts for a large proportion of neonatal deaths [8, 9]. Postnatal care is crucial for monitoring the health of both the mother and baby after birth. It helps to identify any potential complications and get them addressed before they become life-threatening [10, 11]. The Health Belief Model (HBM) suggests that increased awareness about a health issue through social media can enhance perceived benefits and reduce perceived barriers, leading to better health outcomes [12]. Exposure to family planning messages through social media may increase awareness and knowledge about the importance of maternal healthcare services [13, 14]. This increased knowledge and awareness could then translate into greater perceived need and demand for these services among women of reproductive age. Therefore, understanding the association between social media exposure to family planning methods and maternal healthcare service utilization is vital for improving maternal and child health.

Growing evidence suggests that ensuring access to reproductive health services is a critical component for not only health and well-being but also socioeconomic outcomes for women [15,16,17,18]. In many low-middle-income countries, including Mauritania, the uptake of maternal healthcare services is very limited, with a range of factors contributing to this issue. Despite having rich natural resources, the country has been struggling with providing its citizens with basic healthcare services [19,20,21]. Lack of adequate medical facilities and equipment, shortage of trained medical personnel, and insufficient funding are some of the main reasons behind the poor development of healthcare services in Mauritania [22]. The situation is particularly challenging for pregnant women as they require specialized care and regular monitoring. Women often give birth at home without any medical assistance due to limited access to maternity clinics. Furthermore, many women fail to access the services available to them due to lack of knowledge regarding pregnancy complication and familiarity with the healthcare system. The absence of adequate health communication channels exacerbates this issue, making it imperative to explore alternative methods of disseminating information. Inadequate health communication is a common concern in many countries and the healthcare systems are adopting many innovative measures to raise health awareness and improve healthcare-seeking behavior among vulnerable communities. Social media platforms have emerged as a potent tool in this regard, enabling the dissemination of health information, including family planning messages, to remote or hard-to-reach areas due to inadequate transportation facilities. In recent years, the use of social media platforms to disseminate health information has grown rapidly, including family planning messages, to regions that are remote or hard to reach due to inadequate transportation facilities. Studies have explored the potential impact of exposure to family planning messages on social media on maternal healthcare service utilization; [13, 23, 24] however, similar studies are lacking in the context of Mauritania. Therefore, we aim to investigate the association between exposure to family planning messages on social media and maternal healthcare service utilization in Mauritania.

Methods

Data source

The data for this study were obtained from the Mauritania Demographic and Health Survey (MDHS) conducted in 2019-20. Demographic and Health Survey are conducted about once every five years with the aim of collecting quality data on a wide-range of indicators of health, nutrition, fertility levels and mortality. These surveys are conducted using a two-stage stratified cluster design. In the first stage of sampling, households are randomly selected within each primary sampling unit. In the second stage, households within each cluster are chosen through systematic random sampling using an equal probability method. Eligible men and women from these households were then identified and interviewed as part of the data collection process. For this study, a sample of 7,640 married women who who gave birth in last five years were included in the analysis.

Description of the variables

The outcome variable included (1) timing of first of antenatal care (early ANC contact = first ANC visit within 3 month of pregnancy, late ANC contact = first ANC visit after 3 month of pregnancy), (2) adequacy of antenatal care visits during pregnancy (inadequate i.e. 3 ANC visits or lower, adequate i.e. 4 ANC visits or higher), and (3) place of birth (home vs. health facility-based childbirth). Covariates included in the analysis: were exposure to family planning on social media such as Facebook, Twitter, or Instagram? (No, Yes); age; currently married (Yes, No); residency type (urban, rural); year of education, wealth index (poorest, poorer, middle, richer, Richest); health insurance ownership (Yes, No); number of children ever born, wanted last child (wanted then, wanted later, wanted no more); Owns a mobile phone (No, Yes).

Data analysis

Descriptive statistics were used to report the percentages of the three outcome variables (timing and adequacy of ANC visits, and facility-based childbirth) across the socio-demographic characteristics using the svy command (svy accounts for the clustered structure of the surveys). The percentages of early ANC timing, adequacy and health facility-based childbirth by age groups and household wealth index was presented as line charts. The sociodemographic factors associated with timing and adequacy of ANC visits, and facility-based childbirth were estimated using binary logistic regression methods. We ran five different models to assess the relationship between family planning message on social media and maternal healthcare services. Each model included additional control variables to account for various other factors at consecutive steps. Model 1 includes only the variable “Read about FP on social media”. Model 2 included Model 1 and age and marital status. Model 3 included Model 2 and health insurance ownership. Model 4 included parity (total children ever born) and wantedness of the last child. Finally, Model 5 included the socioeconomic factors such as household wealth index, residence type, education, and mobile phone ownership in addition to the variables in Model 4. Statistical significance was determined at a threshold of p < 0.05 for all analyzes. Data analyzes were conducted using Stata 16 and charts were created using R studio.

Results

Table 1 shows the percentage distribution of socio-demographic characteristics by timely ANC visit, adequate ANC visits, and facility-based childbirth. Approximately 65.6% of participants made their first antenatal care (ANC) visit during the first trimester. About 45.1% made adequate (> 3) ANC visits while 75.0% delivered at a health facility. Participants who reported seeing family planning information on social media had a relatively higher percentage of timely ANC visits (6.3% vs. 8.2%) and four or more ANC visits (5.9% vs. 8.9%). These participants also had a higher rate of health facility childbirth (1.9% vs. 9.0%).

Table 1 Percentage distribution of socio-demographic characteristics by timely ANC visit, adequate ANC visits, and facility-based childbirth

Fig. 1

Proportions of early ANC timing, adequacy and health facility-based childbirth by age groups and household wealth index

Figure 1 presents the proportions of making at least one and four ANC visits, early ANC timing, health facility-based childbirth. As illustrated by the figure, the proportions of receiving timely and adequate ANC visits and health facility-based childbirth were higher among women in the richer wealth quintile households.

Table 2 presents the odds ratios of early timing of antenatal care in Mauritania. The odds of early antenatal care increased with higher age of the woman (OR = 1.03, 95% CI = 1.01,1.04) and with having health insurance (OR = 1.39, 95% CI = 1.11,1.73). Having fewer total children ever born was also associated with higher odds of early antenatal care (OR = 0.91, 95% CI = 0.87,0.95). Women who wanted their last child later had lower odds of early antenatal care compared to women who wanted their last child at that time. (OR = 0.77, 95% CI = 0.65,0.91). Regarding wealth index, women in the poorer category had higher odds of early antenatal care (OR = 1.31, 95% CI = 1.03,1.66) compared to those in the poorest category, while there was no significant association for the other wealth categories. There was also no significant association between urban or rural residence, years of education, and early antenatal care.

Table 2 Odds ratios of early timing of antenatal care in Mauritania 2019-21

The results of Table 3 indicates that reading about family planning on social media was significantly associated with higher odds of receiving adequate antenatal care visits (OR = 1.38, 95% CI = 1.12,1.71). Surprisingly, having health insurance was significantly associated with lower odds of receiving adequate antenatal care visits (OR = 0.70, 95% CI = 0.58,0.85). Having fewer total children ever born was associated with higher odds of receiving adequate antenatal care visits (OR = 0.96, 95% CI = 0.92,1.00). Women who wanted their last child later had lower odds of receiving adequate antenatal care visits compared to those who wanted their last child then (OR = 0.86, 95% CI = 0.73,1.00). In terms of wealth index, women in the poorer (OR = 1.34, 95% CI = 1.08,1.66), middle (OR = 1.65, 95% CI = 1.34,2.02), richer (OR = 1.63, 95% CI = 1.30,2.06), and richest (OR = 2.03, 95% CI = 1.57,2.64) categories had significantly higher odds of receiving adequate antenatal care visits compared to those in the poorest category. Owning a mobile phone showed a positive association with early timing of antenatal care (OR = 1.50, 95% CI = 1.24,1.81).

Table 3 Odds ratios of adequate antenatal care visits in Mauritania 2019-21

Table 4 Odds ratios of health facility-based childbirth in Mauritania 2019-21

Reading about family planning on social media was found to be significantly associated with higher odds of having a health facility-based childbirth (OR = 1.83, 95% CI = 1.09,3.08). (Table 4) Age was positively associated with higher odds of having a health facility-based childbirth (OR = 1.03, 95% CI = 1.02,1.05). Having health insurance was found to be positively associated with having a health facility-based childbirth (OR = 2.07, 95% CI = 1.19,3.62). Total children ever born was negatively associated with odds of having a health facility-based childbirth (OR = 0.86, 95% CI = 0.81,0.90). Regarding wealth index, women in the poorer (OR = 1.94, 95% CI = 1.56,2.41), middle (OR = 5.30, 95% CI = 4.15,6.76), richer (OR = 12.75, 95% CI = 8.79,18.51), and richest (OR = 23.82, 95% CI = 13.17,43.06) categories had significant higher odds of having a health facility-based childbirth compared to those in the poorest category. Women living in rural areas had lower odds of having a health facility-based childbirth compared to those in urban areas (OR = 0.47, 95% CI = 0.36,0.60). Owning a mobile phone showed a positive association with health facility-based childbirth (OR = 1.72, 95% CI = 1.40,2.12).

Discussion

We analyzed the relationship between exposure to family planning messages on social media and maternal healthcare services among Mauritanian women. The findings suggest that while a majority of women in Mauritania deliver their last child in healthcare facilities, there are still opportunities to improve the timely initiation and adequate use of antenatal care (ANC) services. The results indicate no significant association between exposure to family planning messages on social media and early initiation of antenatal care. However, a positive association was found between exposure to these messages and receiving adequate antenatal care visits. The results also indicated a significant positive association between reading about family planning on social media and having a health facility-based childbirth, which may reflect the role of social media in providing information and resources to women on the importance of delivering in a health facility. Overall, this reflects the role of social media in providing women with essential information and resources, helping them better navigate the healthcare system and increasing their awareness of the importance of adequate ANC. Having exposure to family planning messages on social media can provide women with information and resources that may not be accessible through traditional healthcare channels, and thereby enabling them to better understand and navigate the healthcare system including seeking adequate antenatal care and delivering in a health facility. Previously, in a study on Malawi, we found a positive association between media communication regarding family planning and the uptake of maternal healthcare services [13]. In Sierra Leone, exposure to family planning messages on radio and mobile phones was found to have positive associations with using modern contraceptives [23]. While several other studies have highlighted the role of social media use on promoting health and well-being [25,26,27], the current findings extend the beneficial roles on maternal healthcare use as well. Altogether, this reflects the role of social media in providing women with information and resources to better understand and navigate the healthcare system, which may lead to increased awareness of the importance of receiving adequate ANC and having a health facility-based childbirth.

Regarding the sociodemographic factors, we found a positive association between age and early timing of ANC. This is perhaps because of the understanding of the importance of ANC among older women, or may be related to greater access to healthcare services. The positive association between having health insurance and early timing of ANC explains the role of financial barriers in delaying ANC initiation, and the importance of health insurance in reducing those barriers [28,29,30]. Similarly, there is also a positive association between having health insurance and having a health facility-based childbirth. The positive association between the wealth index and choosing health facility-based childbirth for ANC reflects the role of socioeconomic status in accessing healthcare services [31, 32]. with increasing wealth being associated with higher odds of facility-based childbirth. The lower odds of early timing of ANC among women who wanted their last child later explains that women who plan to have more children potentially being less motivated to seek ANC early. Finally, the negative association between living in a rural area and having a health facility-based childbirth reflects the challenges of accessing healthcare services in rural areas, including limited availability of health facilities and providers [33].

The present findings provide important insights into the relationship between social media exposure to family planning messages and maternal healthcare services. The study found that, while a majority of women in Mauritania deliver their last child in healthcare facilities, there are still opportunities to improve the timely initiation and adequate use of antenatal care services. This highlights the need for more comprehensive efforts to improve maternal healthcare services in Mauritania, including increasing awareness of the importance of ANC and providing greater access to healthcare facilities. This highlights the need for more comprehensive efforts to enhance maternal healthcare services in Mauritania, such as increasing awareness of the importance of ANC and expanding access to healthcare facilities. The study also highlighted the potential of social media to improve maternal healthcare services, particularly in providing women with information and resources to better understand and navigate the healthcare system. This suggests that policymakers and healthcare providers should consider leveraging social media platforms to provide information and education on the importance of seeking ANC early and delivering in a health facility. The study’s findings also underscore the importance to address the challenges of accessing healthcare services in rural areas. This may require targeted policies to increase the availability of healthcare facilities and providers in rural areas, as well as efforts to increase awareness of the importance of maternal healthcare services among rural communities. Based on the current fiindings, it is suggestible that policymakers and healthcare providers consider leveraging social media platforms to provide information and education on the importance of seeking ANC early and delivering in a health facility. To enhance the effectiveness of such initiatives, it is crucial for the Government of Mauritania, international organizations, and NGOs to develop and disseminate family planning messages that are tailored to the local context in local languages to ensure they are accessible and understandable to a broad audience. Typical messages should cover comprehensive pregnancy-care related topics such as the importance of antenatal visits, the benefits of health facility-based childbirth, birth spacing, and contraceptive methods. By doing so, maternal health programs can ensure that the information is not only widely disseminated but also culturally relevant and impactful in improving maternal healthcare service utilization.

This study has several important strengths and limitations. The main strength of the study is that it adds to the existing literature on the role of social media messages on family planning to promoting the use of maternal healthcare services. Additionally, the study used a large sample size which increases the statistical power and generalizability of the findings to the Mauritanian population. The limitations of the study include the absence of cultural and healthcare level determinants of maternal health service use, which could affect the generalizability of the findings to other populations. The cross-sectional nature of the data limits the ability to draw conclusions about causality. The analysis suffers the lack of detailed information on the timing and context of participants’ exposure to family planning messages on social media. Exposure to family planning messages may increase awareness about maternal healthcare services and thereby encourage women to seek necessary care by providing information on the importance and availability of these services. Future studies should attempt to account for exact content of the health communications messages as a potential predictors of using health services. There were no data on whether women read these messages during pregnancy, before pregnancy, or even after childbirth. Another important limitation is that we do not have data on participants’ exposure to maternal health messages on social media. It is possible that individuals who were exposed to family planning messages on social media were also more likely to be exposed to maternal health information, which can potentially confound the observed associations in this study. Future studies should attempt to measure and account for maternal health message exposure as a potential covariate in the analysis. Last but not least, the self-reported nature of the data may also be subject to recall bias, which could affect the accuracy of the results.

Conclusion

Overall, the findings suggest that reading about family planning on social media is positively associated with receiving adequate antenatal care visits and having a health facility-based childbirth in Mauritania. However, social media was not found to be associated with early timing of antenatal care. The results also highlight the importance of age, health insurance, total children ever born, wealth index, and rural residence in determining access to antenatal care and facility-based childbirth. Policymakers can leverage social media as an effective tool to provide women with information and resources on the importance of antenatal care and facility-based childbirth. Efforts to increase access to health insurance and reduce financial barriers to accessing healthcare services could also be prioritized. Additionally, strategies to address the challenges faced by women with more children and those residing in rural areas in accessing healthcare services could be implemented, such as improving transportation infrastructure and increasing the availability of healthcare providers in rural areas.