Abstract
BackgroundUniversal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011.MethodsThe data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services.ResultsThe concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004–2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women’s and their husbands’ education were significantly associated with greater use of maternal health care services. In addition, women’s exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services.ConclusionsBangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.
Highlights
Universal access to health care services does not automatically guarantee equity in the health system
The maternal health related Millennium Development Goal (MDG) targets for Bangladesh include reducing maternal mortality rate (MMR) from 574 per 100,000 live births in 1990 to 143 per 100,000 live births by 2015 (a 75% reduction), increasing the proportion of births attended by skilled health personnel from 5% in 1990 to 50% by 2015 and obtaining universal coverage of at least one antenatal care (ANC) visit by 2015
Using a rich set of covariates, we examined the role of different socioeconomic factors in ANC and delivery care services utilization
Summary
Universal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. It has been estimated that in 2013 over a quarter million women died worldwide due to complications during pregnancy and childbirth [1]. The majority of these maternal deaths occurred in low and low-middle income countries because of unavailable, inaccessible, unaffordable or poor quality maternal health care services. The average annual decline in global MMR between 1990 and 2013 was only 2.6 % against 5.5 % required to achieve MDG 5. The average progress is satisfactory, there is a growing debate whether this progress has been inclusive and equitable
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