Abstract
BackgroundDespite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children’s Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization.MethodTwo surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index.ResultsMean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370).ConclusionsOverall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups. Maternal health programs, if properly designed and implemented, can improve access, partially overcoming the negative effects of socioeconomic disparities.
Highlights
Bangladesh shows wide variability in maternal mortality by rural-urban residence, geographical region, and wealth status of households even though the country has achieved remarkable progress in key healthcare indicators like maternal, neonatal, and under-5 mortality in recent years [1]
In comparison to contemporary Bangladesh Demographic and Health Survey (BDHS) data in nearby districts, MNHIB was successful in reducing inequity in receiving antenatal care (ANC) from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370)
Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper
Summary
Bangladesh shows wide variability in maternal mortality by rural-urban residence, geographical region, and wealth status of households even though the country has achieved remarkable progress in key healthcare indicators like maternal, neonatal, and under-5 mortality in recent years [1]. Achieving equity in maternal healthcare utilization was not considered explicitly in health-related MDGs and the emphasis was on overall reductions in MMR and other health outcomes rather than lowering disparity in the utilization of services. In order to achieve a faster rate of progress, it is important to ensure access to essential health care services by all, irrespective of economic status of households [4]. Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. This study examines the effect of MNHIB on inequity in maternal care utilization
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