Household income and women's reproductive strategies in Almaty (Kazakhstan): urban stratification of access to health
- 1Department of Sociology and Social Work, Al-Farabi Kazakh National University, Almaty, Kazakhstan
- 2Public Opinion Research Center, Almaty, Kazakhstan
Abstract
Purpose: The aim of this article is to demonstrate how household financial status and the spatial structure of opportunities in the metropolis are interrelated with women's reproductive strategies in Almaty, where formal access to healthcare is combined with uneven access costs in terms of time, money, quality, and predictability of service delivery.
Methods: The empirical basis consisted of a cross-sectional survey of women of reproductive age in eight districts of Almaty (N = 934). The analysis utilized a scale reliability assessment (Cronbach's α), χ2 contingency tables with Cramer's V, and interdistrict comparisons using the nonparametric Kruskal-Wallis test and the median test. The urban environment was operationalized through an infrastructure provision index, comprising six domains: Education, clinics, retail and service environment, leisure, sports, and safety.
Results: The resulting six-item index demonstrated good internal consistency (Cronbach's α = 0.814; standardized α = 0.815; n = 780). Statistically significant interdistrict heterogeneity was found in accessibility of clinics (χ2 = 16.048; p = 0.025), retail and service infrastructure (χ2 = 28.472; p < 0.001), leisure (χ2 = 32.640; p < 0.001), sports (χ2 = 31.666; p < 0.001), and safety (χ2 = 17.801; p = 0.013), while no differences were found in educational infrastructure (p = 0.844). The most significant predictors of reproductive practices and attitudes were household financial well-being and education level. The results demonstrate that the formal availability of services does not imply equality in actual access to them.
Conclusion: Inequality in reproductive opportunities is reproduced through hidden transaction costs of access, waiting, transportation logistics, the need for paid alternatives, and additional support resources. Neighborhood of residence is not only a territorial characteristic but also an indicator of the organizational structure of everyday life, influencing care-seeking behavior and family planning strategies. The proposed framework of the Atlas of Reproductive Opportunities can be used to identify local bottlenecks and inform targeted preventive and management decisions.
Related
- Associations of Health Insurance, Household Income, and Cost-Related Healthcare Barriers With Routine Medical Checkup Utilization Among U.S. Adults: Evidence From the 2024 BRFSS
- Relationships among rural tourism participation, livelihood capital structure, and household income outcomes: a cross-sectional survey of tourism-participating households in the Yunqiu Mountain Area, Yellow River Basin
- Reproductive success under constraints: Does increased maternal activity during lactation offset poor habitat and individual quality in an income breeder?
- Psychological resilience and monthly household income are the core influencing factors for distress tolerance in patients undergoing maintenance hemodialysis: a cross-sectional study of latent profile analysis
- Associations of dietary diversity with depressive symptoms, anxiety symptoms and their co-occurrence among reproductive-age women in three low- and middle-income countries: a cross-sectional analysis
BibTeX
@article{bakytzhanova2026household,
title = {{Household income and women's reproductive strategies in Almaty (Kazakhstan): urban stratification of access to health}},
author = {Ainur Bakytzhanova and Gulzhan Alimbekova},
journal = {Dialogues in Health},
year = {2026},
month = sep,
doi = {10.1016/j.dialog.2026.100355},
url = {https://doi.org/10.1016/j.dialog.2026.100355},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Household income and women's reproductive strategies in Almaty (Kazakhstan): urban stratification of access to health
AU - Ainur Bakytzhanova
AU - Gulzhan Alimbekova
PY - 2026
DA - 2026/09/29
JO - Dialogues in Health
DO - 10.1016/j.dialog.2026.100355
UR - https://doi.org/10.1016/j.dialog.2026.100355
AB - Purpose: The aim of this article is to demonstrate how household financial status and the spatial structure of opportunities in the metropolis are interrelated with women's reproductive strategies in Almaty, where formal access to healthcare is combined with uneven access costs in terms of time, money, quality, and predictability of service delivery. Methods: The empirical basis consisted of a cross-sectional survey of women of reproductive age in eight districts of Almaty (N = 934). The analysis utilized a scale reliability assessment (Cronbach's α), χ2 contingency tables with Cramer's V, and interdistrict comparisons using the nonparametric Kruskal-Wallis test and the median test. The urban environment was operationalized through an infrastructure provision index, comprising six domains: Education, clinics, retail and service environment, leisure, sports, and safety. Results: The resulting six-item index demonstrated good internal consistency (Cronbach's α = 0.814; standardized α = 0.815; n = 780). Statistically significant interdistrict heterogeneity was found in accessibility of clinics (χ2 = 16.048; p = 0.025), retail and service infrastructure (χ2 = 28.472; p < 0.001), leisure (χ2 = 32.640; p < 0.001), sports (χ2 = 31.666; p < 0.001), and safety (χ2 = 17.801; p = 0.013), while no differences were found in educational infrastructure (p = 0.844). The most significant predictors of reproductive practices and attitudes were household financial well-being and education level. The results demonstrate that the formal availability of services does not imply equality in actual access to them. Conclusion: Inequality in reproductive opportunities is reproduced through hidden transaction costs of access, waiting, transportation logistics, the need for paid alternatives, and additional support resources. Neighborhood of residence is not only a territorial characteristic but also an indicator of the organizational structure of everyday life, influencing care-seeking behavior and family planning strategies. The proposed framework of the Atlas of Reproductive Opportunities can be used to identify local bottlenecks and inform targeted preventive and management decisions.
SN - 2772-6533
ER -