Abstract
ABSTRACTBackground: Improving maternal health is a major development goal, with ambitious targets set for high-mortality countries like Bangladesh. Following a steep decline in the maternal mortality ratio over the past decade in Bangladesh, progress has plateaued at 196/100,000 live births. A voucher scheme was initiated in 2007 to reduce financial, geographical and institutional barriers to access for the poorest.Objective: The current paper reports the effect of vouchers on the use of continuum of maternal care.Methods: Cross-sectional surveys were carried out in the Chattogram and Sylhet divisions of Bangladesh in 2017 among 2400 women with children aged 0–23 months. Using Cluster analysis utilisation groups for antenatal care, facility delivery and postnatal care were formed. Clusters were regressed on voucher receipt to identify the underlying relationship between voucher receipt and utilisation of care while controlling for possible confounders.Results: Four clusters with varying levels of utilisation were identified. A significantly higher proportion of voucher-recipients belonged to the high-utilisation cluster compared to non-voucher recipients (43.5% vs. 15.4%). For the poor voucher recipients, the probability of belonging to the high-utilisation cluster was higher compared to poor non-voucher recipients (33.3% vs. 6.8%) and the probability of being in the low-utilisation cluster was lower than poor non-voucher recipients (13.3% vs. 55.4%).Conclusion: The voucher programme enhanced uptake of the complete continuum of maternal care and the benefits extended to the most vulnerable women. However, a lack of continued transition through the continuum of maternal care was identified. This insight can assist in designing effective interventions to prevent intermittent or interrupted care-seeking. Programmes that improve access to quality healthcare in pregnancy, childbirth and the postnatal period can have wide-ranging benefits. A coherent continuum-based approach to understanding maternal care-seeking behaviour is thus expected to have a greater impact on maternal, newborn and child health outcomes.
Highlights
Improving maternal health is a major development goal, with ambitious targets set for high-mortality countries like Bangladesh
In Bangladesh, there has been a steep decline in the maternal mortality ratio during the past decade, it has plateaued at around 196 per 100,000 live births during 2008–2016 [2]
A targeted voucher scheme meant for poor pregnant women (having a maximum household monthly income of Bangladeshi Taka 2500) the Maternal Health Voucher Scheme (MHVS) covers three antenatal care (ANC), delivery at a health facility, one postnatal care (PNC), management of maternal complications including caesarean delivery where required, free medicines, cash allowances for transportation, and a cash incentive to deliver at a health facility
Summary
Improving maternal health is a major development goal, with ambitious targets set for high-mortality countries like Bangladesh. In Bangladesh, there has been a steep decline in the maternal mortality ratio during the past decade, it has plateaued at around 196 per 100,000 live births during 2008–2016 [2]. Barriers such as out-of-pocket expenses, inequitable access to services and delay in care-seeking have been associated with the risk of maternal complications [3]. PNC, especially within the first 48 hours of delivery is critical in detecting and managing maternal and newborn complications such as sepsis and difficulties with establishing lactation Each of these interventions is important and should be included in a continuum of maternal care (CoC) to ensure the health of both
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