Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?

Abstract

BackgroundUniversal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011.MethodsThe data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services.ResultsThe concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004–2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women’s and their husbands’ education were significantly associated with greater use of maternal health care services. In addition, women’s exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services.ConclusionsBangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.

Persistent inequity in maternal health care utilization in Nepal despite impressive overall gains

“…These findings are in line with previous investigations of the distribution of health care utilization over time,[16,17] where improvements happen simultaneously in various groups in society. [18] The tendency for the health gains to be realized earlier in urban areas and among those of high socioeconomic status indicates a need for targeted interventions to reach the most disadvantaged and vulnerable.…”

Inequalities in Utilization of Maternal Reproductive Health Care Services in Urban Bangladesh: A Population-Based Study

“…Bangladesh has achieved notable success in maternal health care service utilization during and following the implementation of the Millennium Development Goals between 2000 and 2015. Currently, around 64% of the total women receive at least one antenatal care consultation during pregnancy, of which 32% visit antenatal care services four or more times (Islam & Masud, 2018;NIPORT et al, 2012;Pulok et al, 2016). More than one third (37%) of women received health care services by the skilled health personnel during delivery and received postnatal care services within 2 days of delivery (NIPORT et al, 2016).…”

“…This success is attributable mainly to the public facilities offering services free of cost, and some contributions of the nongovernment and charity organizations, as well as the broad media coverage regarding the importance of these services (NIPORT et al, 2016). However, utilization of maternal reproductive health care services are still low, particularly among the rural women, women with lower education and socioeconomic status, and those who have limited autonomy to visit health care facilities (M. N. Khan & Islam, 2018;NIPORT et al, 2016;Pulok et al, 2016). Importantly, these are common among urban disadvantaged women.…”

“…Ensuring appropriate health care services for women amid a rapidly growing urban population is challenging. Limited studied have focused on the maternal health care inequalities (Haider et al, 2017;Mahabub-Ul-Anwar et al, 2006), particularly for urban women (Ahmed et al, 2005; M. M. H. Khan et al, 2011;Pulok et al, 2016). Moreover, most of the existing studies examining the inequalities adopted conventional regressions, which are not well-suited for estimating inequalities.…”

Mensuração de desigualdades sociais em saúde: conceitos e abordagens metodológicas no contexto brasileiro*

“…[2][3][4] In addition, promoting equality among these subgroups and prioritizing the improvement of indicators among vulnerable groups may be an efficient strategy to improve the national indicators. [4][5][6][7] The Sustainable Development Goals (SDG) proposed by the United Nations in 2015, on the basis of the Millennium Development Goals (MDG), emphasize the importance of universal health care and the need to tackle inequality. 5 Even though inequality and iniquity are often presented as synonyms, they are in fact two different concepts.…”