Understanding the Association of Savings and Internal Lending Communities (SILCs) Participation and Household Wealth and Access of Reproductive Health Services (RHSs) in Rural Zambia

Abstract

Background: Poverty often prevents women from seeking, reaching, and receiving the full continuum of reproductive health services (RHSs). Savings and Internal Lending Communities(SILCs) are a type of informal microfinance mechanism designed to financially empower poor people living in rural areas. SILCs are often paired with additional health and non-health related interventions. However, limited studies have examined SILCs in the context of maternal health as a financial intervention to overcome financial barriers to accessing RHSs. Objective: The objectives of this research are to use the socioecological model to: 1) examine how Saving Groups (SGs) like SILCs have been used as a financial intervention to overcome financial barriers to accessing RHSs, 2) understand the association between having access to SILC, household wealth, financial preparedness for birth, and utilization of RHSs, 3) understand the association between SILC participation, household wealth, and financial preparedness for birth, and 4) examine the association between sex and financial preparedness for birth. Methods: Three studies were conducted to address the objectives. First, a scoping review was conducted to examine the impact of SGs as a financial intervention on utilization of RHSs. Second, a secondary analysis was conducted on baseline (n=2381) and endline (n=2330) household survey data where the samples were stratified into three community groups (CGs): CG1) communities with access to neither SILCs nor Maternity Waiting Homes (MWHs), CG2)communities with access to MWHs only, and CG3) communities with access to both SILCs and MWHs. Multiple linear regression models, binary logistic regression models, and interactionFacility (HF) delivery, and Skilled Provider (SP) delivery, but not with household wealth, financial preparedness for birth, Antenatal Care (ANC), and Postnatal Care (PNC) visits. Women with access to both MWHs and SILCs had higher odds of utilizing MWH, delivering at a HF with a SP compared to women who had access to neither MWHs nor SILCs. Finally, secondary analysis of SILC participation survey showed SILC participation led to increased household wealth. Participants who had their most recent childbirth after joining SILCs had higher odds of being financially prepared than those who had their most recent childbirth before joining SILCs. Furthermore, females were more likely to be financially prepared for birth compared to men only for the participants who had their most recent delivery before joining SILCs. Conclusion: Overall, the findings of the three studies suggest that SILCs are a promising financial intervention to help poor and rural population to overcome financial barriers to accessing RHSs. However, SILCs alone may not be sufficient to provide enough financial resources to utilize the full continuum of RHSs.