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

Pulok, Mohammad Habibullah and Sabah, Md Nasim-Us Sabah and Uddin, Jalal and Enemark, Ulrika (2015): Progress in utilization of antenatal and delivery care services in Bangladesh: Where does the equity gap lie?

Abstract

Despite a central element of the Millennium Development Goals (MDGs), the progress in making pregnancy and childbearing safer for women has been slow in many developing countries. Though Bangladesh has achieved commendable progress in reducing maternal mortality in recent decades, the country faces pervasive inequity in antennal (ANC) and delivery care services. The purpose of this study is to provide recent estimates of trend in inequity in antenatal and delivery care services in Bangladesh during 2004-2011. We employ rich-poor ratio, concentration curve and concentration index to examine the trends of inequities in ANC and delivery care services using the latest three waves of Bangladesh Demographic and Health Survey. This study uses logistic regression analysis to investigate the relationship between socioeconomic factors and six indicators of ANC and delivery care. Concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 while it remained around 0.20 for receiving ANC from medically trained provider. Findings indicate that inequity in delivery at health facility and delivery by caesarean section decreased by about 33% in between 2004 and 2011. Women from the richest households were about 3 times more likely to have 4+ ANC visits (OR=2.91, 95% CI: 2.24-3.78), delivery at health facility (OR=3.16, 95% CI: 2.40-4.17), and skilled assistance at birth (OR=3.32, 95% CI: 2.51-4.38) compared to women from the poorest households. There was an overall progress in reducing inequity in utilization of maternal health care but rural area lagged behind to achieve equity compared to urban area. The evidence of inequity in maternal health care utilization highlights that the country faces not only a persistent equity gap between rich and poor women but also substantial rural-urban inequity. It is essential to design multi-sectoral and concerted interventions from an equity perspective to accelerate safe motherhood and childbirth in Bangladesh.

• Item Type: MPRA Paper
• Language: English
• Keywords: Antennal care, Bangladesh, delivery care, concentration index, inequity.
• Subjects: I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I14 - Health and Inequality; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

Adams AM, Rabbani A, Ahmed S, et al. 2013. Bangladesh: Innovation for Universal Health Coverage 4: Explaining equity gains in child survival in Bangladesh: Scale, speed, and selectivity in health and development. The Lancet 382: 2027–37.

Ahmed S, Khan MM. 2011. Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh. Social science & medicine 72: 1704–10.

Ahmed SM, Hossain MA, Chowdhury MR. 2009. Informal sector providers in Bangladesh: how equipped are they to provide rational health care? Health policy and planning 24: 467–78.

Amin R, Becker S, Bayes a. 1998. NGO-promoted microcredit programs and women’s empowerment in rural Bangladesh: quantitative and qualitative evidence. Journal Of Developing Areas 32: 221–36.

Amin R, Shah NM, Becker S. 2010. Socioeconomic factors differentiating maternal and child health-seeking behavior in rural Bangladesh: A cross-sectional analysis. International journal for equity in health 9: 9.

Anwar ATMI, Killewo J, Chowdhury M-E-EK, Dasgupta SK. 2004. Bangladesh : Inequalities in Utilization of Maternal Health Care Services, Evidence from MATLAB. World Bank, Washington, DC.

El Arifeen S, Hill K, Ahsan KZ, Jamil K, Nahar Q, Streatfield PK. 2014. Maternal mortality in Bangladesh: a Countdown to 2015 country case study. Lancet 384: 1366–74.

Babalola S, Fatusi A. 2009. Determinants of use of maternal health services in Nigeria--looking beyond individual and household factors. BMC pregnancy and childbirth 9: 43.

Barros AJD, Ronsmans C, Axelson H, et al. 2012. Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. Lancet 379: 1225–33.

Cavallaro FL, Cresswell JA, França GV, Victora CG, Barros AJ, Ronsmans C. 2013. Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa. Bulletin of the World Health Organization 91: 914–22D.

Chakraborty N, Islam MA, Chowdhury RI, Bari W, Akhter HH. 2003. Determinants of the use of maternal health services in rural Bangladesh. Health promotion international 18: 327–37.

Choudhury N, Ahmed SM. 2011. Maternal care practices among the ultra poor households in rural Bangladesh: a qualitative exploratory study. BMC pregnancy and childbirth 11: 15.

Collin SM, Anwar I, Ronsmans C. 2007. A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991-2004). International journal for equity in health 6: 9.

Van Eijk AM, Bles HM, Odhiambo F, et al. 2006. Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reproductive health 3: 2.

Filmer D, Pritchett LH. 2001. Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India. Demography 38: 115–32.

Government of Bangladesh (GOB). 1997. Health and Population Sector Strategy 1996

Haque SE, Rahman M, Mostofa MG, Zahan MS. 2012. Reproductive health care utilization among young mothers in Bangladesh: does autonomy matter? Women’s health issues : official publication of the Jacobs Institute of Women's Health 22: e171–80.

Hossain MI. 2010. Inequality in the utilization of maternal care and the impact of a macroeconomic policy: Evidence from Bangladesh. No. HEDG Working Paper 10/08., The University of York.

Houweling TAJ, Ronsmans C, Campbell OMR, Kunst AE. 2007. Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bulletin of the World Health Organization 85: 745–54.

ICF International. 2012. Demographic and Health Survey Sampling and Household Listing Manual., Calverton, Maryland, U.S.A.

Ir P, Horemans D, Souk N, Van Damme W. 2010. Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia. BMC pregnancy and childbirth 10: 1.

Jahan R. 2007. Securing maternal health through comprehensive reproductive health services: lessons from Bangladesh. American journal of public health 97: 1186–90.

Jesmin SS, Chaudhuri S, Abdullah S. 2013. Educating women for HIV prevention: does exposure to mass media make them more knowledgeable? Health care for women international 34: 303–31.

Karim F, Tripura A, Gani MS, Chowdhury AMR. 2006. Poverty status and health equity: evidence from rural Bangladesh. Public health 120: 193–205.

Khan MMH, Krämer A, Khandoker A, Prüfer-Krämer L, Islam A. 2011. Trends in sociodemographic and health-related indicators in Bangladesh, 1993-2007: will inequities persist? Bulletin of the World Health Organization 89: 583–93.

Koblinsky M, Anwar I, Mridha MK, Chowdhury ME, Botlero R. 2008. Reducing maternal mortality and improving maternal health: Bangladesh and MDG 5. Journal of health, population, and nutrition 26: 280–94.

Lozano R, Wang H, Foreman KJ, et al. 2011. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 378: 1139–65.

Matsumura M, Gubhaju B. 2001. Women’s status household structure and the utilisation of maternal health services in Nepal. Asia-Pac Popul J 2001 16: 23–44.

Ministry of Health and Family Welfare(MOHFW). 2001. Bangladesh National Strategy for Maternal Health., Dhaka, Bangladesh.

National Institute of Population Research and Training (NIPORT), Associates M and, ICF International. 2013. Bangladesh demographic and health survey 2011., Calverton, Maryland.

Nguyen HTH, Hatt L, Islam M, et al. 2012. Encouraging maternal health service utilization: an evaluation of the Bangladesh voucher program. Social science & medicine 74: 989–96.

Osmani LNK. 1998. Impact of Credit on the Relative Well-Being of Women: Evidence from the Grameen Bank. IDS Bulletin 29: 31–8.

Owen O’Donnell, Doorslaer E van, Wagstaff A, Magnus L. 2008. Analyzing Health Equity Using Household Survey Data: a Guide to Techniques and Their Implementation. The World Bank: Washington, DC.

Quayyum Z, Khan MNU, Quayyum T, Nasreen HE, Chowdhury M, Ensor T. 2013. ‘Can community level interventions have an impact on equity and utilization of maternal health care’ - evidence from rural Bangladesh. International journal for equity in health 12: 22.

Raghupathy S. 1996. Education and the use of maternal health care in Thailand. Social Science & Medicine 43: 459–71.

Rahman KMM. 2009. Detrminants of Maternal Health Care Utilization in Bangladesh. Research Journal of Applied Sciences 4: 113–9.

Regassa N. 2011. Antenatal and postnatal care service utilization in southern Ethiopia: a population-based study. African health sciences 11: 390–7.

Ronsmans C, Graham WJ. 2006. Maternal mortality: who, when, where, and why. Lancet 368: 1189–200. Rutstein SO, Johnson K. 2004. The DHS Wealth Index: DHS Comparative Reports No. 6., Calverton, Maryland USA.

Sosa-Rubí SG, Walker D, Serván E, Bautista-Arredondo S. 2011. Learning effect of a conditional cash transfer programme on poor rural women’s selection of delivery care in Mexico. Health policy and planning 26: 496–507.

Story WT, Burgard SA. 2012. Couples’ reports of household decision-making and the utilization of maternal health services in Bangladesh. Social science & medicine (1982) 75: 2403–11.

Subramanian S V, Perkins JM, Özaltin E, Davey Smith G. 2011. Weight of nations: a socioeconomic analysis of women in low- to middle-income countries. The American journal of clinical nutrition 93: 413–21.

Uddin J, Hossin MZ, Mahbub F, Hossain MZ. Healthcare-seeking behavior among the Chakma ethnic group in Bangladesh: can accessibility and cultural beliefs shape healthcare utilization? International quarterly of community health education 33: 375–89.

UN. 2014. The Millennium Development Goals Report., New York. U.S.A.

UNDESA. 2013. World Population Prospects: The 2012 Revision.

UNICEF. 2010. Narrowing the gaps to meet the goals., New York, U.S.A.

Wagstaff A. 2005. The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health economics 14: 429–32.

Wagstaff A, van Doorslaer E. 2004. Overall versus socioeconomic health inequality: a measurement framework and two empirical illustrations. Health economics 13: 297–301.

Wagstaff A, van Doorslaer E, Paci P. 1991a. On the measurement of horizontal inequity in the delivery of health care. Journal of health economics 10: 169–205; discussion 247–9, 251–6.

Wagstaff A, Paci P, van Doorslaer E. 1991b. On the measurement of inequalities in health. Social science & medicine (1982) 33: 545–57. WHO. 2002. Antenatal Care Randomized Trial: Manual for the Implementation of the New Model., Geneva, Swithzerland.

WHO. 2014. Trends in Mternal Mortality: 1990-2013. Estimates by WHO,UNICEF, UNIFPA, The World Bank and the United Nations population Division., Geneva, Swithzerland.

Zere E, Kirigia JM, Duale S, Akazili J. 2012. Inequities in maternal and child health outcomes and interventions in Ghana. BMC public health 12: 252. Zere E, Moeti M, Kirigia J, Mwase T, Kataika E. 2007. Equity in health and healthcare in Malawi: analysis of trends. BMC public health 7: 78. Zere E, Suehiro Y, Arifeen A, Moonesinghe L, Chanda SK, Kirigia JM. 2013. Equity in reproductive and maternal health services in Bangladesh. International journal for equity in health 12: 90.