The relationship between extended kin resources and children's healthcare utilization: An analysis of family networks

Extended kin serve as key sources of financial, social, and instrumental support for young children and their families. In impoverished settings, the ability to rely on extended kin for investments, information, and/or in-kind support to access health care when needed may be particularly important in buffering children against poor health outcomes and mortality. Given data limitations, little is known about how specific social and economic characteristics of extended kin shape children's healthcare access and health outcomes. We use detailed household survey data from rural Mali, where related households co-reside in extended family compounds, a living arrangement typical across West Africa and other settings globally. We examine how specific social and economic characteristics of extended kin residing in close geographic proximity affect children's healthcare utilization in a sample of 3948 children under five years of age reporting illness in the preceding two weeks. Absolute wealth among extended family networks is associated with utilization of any healthcare and healthcare with a formally-trained provider, an indicator of health service quality (adjusted odds ratio (aOR) = 1.29, 95% CI 1.03, 1.63; aOR = 1.49, 95% CI 1.17, 1.90, respectively). Net of maternal characteristics, educational attainment and decision-making power of extended female relatives of reproductive age in the concession network are powerful predictors of any healthcare utilization (aOR = 1.69, 95% CI 1.18, 2.42; aOR = 1.59, 95% CI 1.27, 1.99, respectively). Labor force participation among extended relatives is not associated with healthcare utilization outcomes among young children, while maternal labor force participation is predictive of utilization of any care and care with a formally-trained provider (aOR = 1.41, 95% CI 1.12, 1.78; aOR = 1.36, 95% CI 1.11, 1.67, respectively). These findings underscore the importance of financial and instrumental support from extended family and illuminate the ways extended families work together to return young children to health in the face of resource constraints.