Abstract
BackgroundPersistent inequities in coverage of maternal and newborn health (MNH) services continue to pose a major challenge to the health-care system in Nepal. This paper uses a novel composite indicator of intersectional (dis) advantages to examine how different (in) equity markers intersect to create (in) equities in contact coverage of MNH services across the continuum of care (CoC) in Nepal.MethodsA secondary analysis was conducted among 1978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The three outcome variables included were 1) at least four antenatal care (4ANC) visits, 2) institutional delivery, and 3) postnatal care (PNC) consult for newborns and mothers within 48 h of childbirth. Independent variables were wealth status, education, ethnicity, languages, residence, and marginalisation status. Intersectional (dis) advantages were created using three socioeconomic variables (wealth status, level of education and ethnicity of women). Binomial logistic regression analysis was employed to identify the patterns of (in) equities in contact coverage of MNH services across the CoC.ResultsThe contact coverage of 4ANC visits, institutional delivery, and PNC visit was 72, 64, and 51% respectively. Relative to women with triple disadvantage, the odds of contact coverage of 4ANC visits was more than five-fold higher (Adjusted Odds Ratio (aOR) = 5.51; 95% CI: 2.85, 10.64) among women with triple forms of advantages (literate and advantaged ethnicity and higher wealth status). Women with triple advantages were seven-fold more likely to give birth in a health institution (aOR = 7.32; 95% CI: 3.66, 14.63). They were also four times more likely (aOR = 4.18; 95% CI: 2.40, 7.28) to receive PNC visit compared to their triple disadvantaged counterparts.ConclusionsThe contact coverage of routine MNH visits was low among women with social disadvantages and lowest among women with multiple forms of socioeconomic disadvantages. Tracking health service coverage among women with multiple forms of (dis) advantage can provide crucial information for designing contextual and targeted approaches to actions towards universal coverage of MNH services and improving health equity.
Highlights
In low- and lower-middle-income countries (LMICs), preventable maternal and newborn morbidities and mortalities continue to be major public health problems [1]
The contact coverage of routine maternal and newborn health (MNH) visits was low among women with social disadvantages and lowest among women with multiple forms of socioeconomic disadvantages
These MNH interventions can be provided during antenatal care (ANC) visits, delivering babies at health facilities assisted by skilled health providers, and postnatal care (PNC) visits within the first month of childbirth [3]
Summary
In low- and lower-middle-income countries (LMICs), preventable maternal and newborn morbidities and mortalities continue to be major public health problems [1]. An analysis of multi-country data, suggests neonatal mortality among mothers of the lowest wealth quintile declined only marginally compared to mothers of the highest wealth quintile [2] This suggests, despite overall increases in health services access, survival advantages are disproportionately distributed across different wealth strata. Most maternal and neonatal deaths can be reduced through the uptake of a range of essential maternal and newborn health (MNH) interventions during pregnancy, childbirth, and the postnatal period These MNH interventions can be provided during antenatal care (ANC) visits, delivering babies at health facilities assisted by skilled health providers, and postnatal care (PNC) visits within the first month of childbirth [3]. Persistent inequities in coverage of maternal and newborn health (MNH) services continue to pose a major challenge to the health-care system in Nepal. This paper uses a novel composite indicator of intersectional (dis) advantages to examine how different (in) equity markers intersect to create (in) equities in contact coverage of MNH services across the continuum of care (CoC) in Nepal
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