Abstract
BackgroundMost existing research on rural–urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural–urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China.MethodsUtilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015–2019) and 25,849 live births in City B (2018–2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable.ResultsWhile there is no statistically significant difference in rural and urban mothers’ probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively.ConclusionsRural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services.
Highlights
The literature on rural–urban differences in maternal health has generally focused on inequalities created by geographic differences
We focus on three important indicators that can be extracted from this administrative dataset: whether the mother obtained the minimum recommended number of prenatal care checkups, mode of delivery (Cesarean section versus natural delivery), the level of the hospital, and fees incurred for delivery
In City B, the probability of obtaining the minimum recommended number of prenatal care visits was lower for mothers with rural hukou status than for mothers with urban hukou status (62.08 % versus 68.18 %)
Summary
The literature on rural–urban differences in maternal health has generally focused on inequalities created by geographic differences. Studies have found that mothers living in rural communities ( those in most developing countries) tend to have more restricted access to healthcare (including prenatal checkups, attendance by medical professionals, and Cesarean section) [1,2,3,4] and higher rates of adverse obstetric symptoms and maternal mortality than their counterparts living in urban communities [5,6,7,8,9,10] These disparities are usually attributed to the lower socioeconomic status of rural residents and the lower density of healthcare providers in rural communities [1, 11,12,13,14]. This paper examines rural–urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China
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