Inequality in the use of maternal and child health services in the Philippines: do pro-poor health policies result in more equitable use of services?

Abstract

BackgroundThe Philippines failed to achieve its Millennium Development Goal (MDG) commitment to reduce maternal deaths by three quarters. This, together with the recently launched Sustainable Development Goals (SDGs), reinforces the need for the country to keep up in improving reach of maternal and child health (MCH) services. Inequitable use of health services is a risk factor for the differences in health outcomes across socio-economic groups. This study aims to explore the extent of inequities in the use of MCH services in the Philippines after pro-poor national health policy reforms.MethodsThis paper uses data from the 2008 and 2013 Demographic and Health Survey (DHS) in the Philippines. Socio-economic inequality in MCH services use was measured using the concentration index. The concentration index was also decomposed in order to examine the contribution of different factors to the inequalities in the use of MCH services.ResultsIn absolute figures, women who delivered in facilities increased from 2008 to 2013. Little change was noted for women who received complete antenatal care and caesarean births. Facility deliveries remain pro-rich although a pro-poor shift was noted. Women who received complete antenatal care services also remain concentrated to the rich. Further, there is a highly pro-rich inequality in caesarean deliveries which did not change much from 2008 to 2013. Household income remains as the most important contributor to the resulting inequalities in health services use, followed by maternal education. For complete antenatal care use and deliveries in government facilities, regional differences also showed to have important contribution.ConclusionThe findings suggest inequality in the use of MCH services had limited pro-poor improvements. Household income remains to be the major driver of inequities in MCH services use in the Philippines. This is despite the recent national government-led subsidy for the health insurance of the poor. The highly pro-rich caesarean deliveries may also warrant the need for future studies to determine the prevalence of medically unindicated caesarean births among high-income women.Trial registrationNot applicable.

Socioeconomic inequality and determinants of postnatal home visits made by public health midwives: An analysis of the Sri Lanka Demographic and Health Survey

“…Another application of inequality analysis is tracking health inequalities over time. It helps to understand the effect of new health interventions or policy measures in terms of reducing health inequalities as well as inequities [22, 40, 41]. Sri Lankan health authorities should incorporate health inequality measures into existing health indicators to track progress over time in reducing inequalities.…”

“…The explanatory variables used in the decomposition analysis were education level of women, ethnicity, education level of husband/partner, sector of residence, province of residence, and the wealth quintile. These covariates were selected a priori, in line with similar studies available in the literature [19–22]. Also, these covariates are recognised as social determinants of health that are closely linked with both health inequalities and inequities [23].…”

Addressing the huge poor–rich gap of inequalities in accessing safe childbirth care: A first step to achieving universal maternal health coverage in Tanzania

“…Education level was categorized as “none” for women who had not received any kind of formal education, “primary” for women who completed primary education level, “secondary” for women who completed secondary education level, and “highest” for women who completed college and all university level; Marital status was categorized as “no spouse” for women who were single, divorced, separated or widowed and "living with spouse" for women who were married or living with a partner during the interview; Employment was categorized as "employed" for women who reported to be employed and paid in salary in terms of cash and "not employed" for those who did not have any kind of job and paid in terms of cash. The selection of these variables was based on previous studies related to socioeconomic inequalities in accessing maternal healthcare [ 19 – 22 ].…”

Constraints to Get Access in Maternal Healthcare: A Review from Lower-middle-Income Countries

“…Consequently, women from lower socioeconomic strata are generally exposed to various types of perinatal complexities including premature birth, low birth weight, restricted growth in intra-uterine, antenatal and neonatal mortality, etc. (De Groot et al, 2019;Paredes, 2016;Zere et al, 2013).…”

“…Evidence from sub-Saharan Africa showed that the poor women are the worst sufferer of maternal health complexities due to out of pocket health payments (McKinnon et al, 2016;C. Zhang et al, 2019) as a result women from families having less wealth are at higher risk of death (Paredes, 2016;Rajesh Kumar Rai et al, 2012;Walton & Schbley, 2013). This is the picture of Pakistan also, along with other lower-middle-income countries in South-Asia (Mumtaz et al, 2014), besides, the study of Zere et al (2013) and Walton and Schbley (2013) demonstrated that in Bangladesh, the use of ANC is more common among women from wealthier section than the poor counterparts.…”