Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study

Espen Bjertness,Thein Thein Htay,Johanne Sundby,Tippawan Liabsuetrakul,Myint Myint Wai,Aye Nyein Moe Myint

doi:10.1186/s12939-018-0778-0

Abstract

BackgroundEquity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of antenatal and delivery care have been reported in many countries, but have not yet been studied in Myanmar. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar.MethodsA community-based cross-sectional survey using multistage sampling was conducted from October to November 2016. A wealth index was selected as the main socioeconomic parameter for measuring inequities with respect to early initiation of antenatal care (ANC), number of antenatal care visits, delivery by a skilled birth attendant (SBA) and delivery by cesarean section (CS). Inequities were evaluated using concentration curves and concentration indexes.ResultsOf the 762 women who gave birth within the 12-month survey period, there was no evidence of inequity in utilization of ANC; however, inequity of at least one antenatal visit among women aged less than 20 years was found with a concentration index of 0.04. The concentration indexes for delivery by SBA and CS were 0.05 and 0.14, respectively. Delivery by CS was disproportionately higher in adolescents and women with higher education than middle school.ConclusionThere was no overall inequity in the utilization of ANC but substantial inequities in delivery by CS and SBA were shown. Social determinants of health, particularly age and education, were associated with inequities in the utilization of delivery care. Adolescent pregnant women were found to be particularly vulnerable, and thus should be a target group for strategic plans to reduce inequities in utilization of delivery care.

Highlights

Equity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage
88.5% and 26.8% of them delivered with a skilled birth attendant (SBA) or by cesarean section, respectively (Table 1)
We found inequities in the utilization of delivery care both for delivery by a SBA and by cesarean section, which was in accordance with studies from Namibia and rural China which explained the inequities by noting many of the women were poor and uneducated, high hospital fees, and lack of accessibility and availability, which were common in these two countries [34, 39]

Summary

Introduction

Equity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar. Deaths due to pregnancy and childbirth, remain the leading cause of death among women of reproductive age in low-income countries [2]. The ability to seek and receive health care services should be equal for all socio-economic groups in the interests of fairness and social justice [8], either equity or inequity in the utilization of ANC and delivery care have manifested differently across countries [5, 9]. Substantial socioeconomic gaps, defined by wealth and level of education, were shown to be related with maternal health care services in previous studies [5, 13]; the analyses of inequities are limited in Myanmar.

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Discussion

Conclusion