Abstract
BackgroundNotwithstanding the significant progress in reducing maternal mortality in recent years, social inequalities in the utilization of maternal care continue to be a challenge in Bangladesh. In this study, we aim to provide a comprehensive analysis of trends in social inequalities in utilization of antenatal care (ANC), facility based delivery (FBD), and skilled birth attendance (SBA) in Bangladesh between 1995 and 2010.MethodsData were extracted from the five latest rounds of Bangladesh Demographic Health Surveys (BDHS). The Theil index (T) and between-group variance (BGV) were used to calculate relative and absolute disparities in the utilization of three measures (ANC, FBD, and SBA) of maternal care across six administrative regions. The relative and slope indices of inequality (RII and SII, respectively) were also used to calculate wealth- and education-based inequality in the utilization of maternal care.ResultsThe results of the T-index suggest that relative inequality in SBA has declined by 0.2% per year. Nevertheless, the estimated BGV demonstrated that absolute inequalities in all three measures of maternal care have increased across administrative divisions. For all three measures of maternal care, the RII and SII indicated consistent socioeconomic inequalities favouring wealthier and more educated women. The adjusted RII suggested that wealth- and education-related inequalities for ANC declined by 9% and 6%, respectively, per year during the study period. The adjusted SII, however, showed that wealth- and education-related inequalities for FBD increased by 0.6% per year.ConclusionsAlthough socially disadvantaged mothers increased their utilization of care relative to mothers of higher socioeconomic status, the absolute gap in utilization of care between socioeconomic groups has increased over time. Our findings indicate that wealthier and more educated women, as well as those living in urban areas, are the major users of ANC, FBD and SBA in Bangladesh. Thus, priority focus should be given to implementing and evaluating interventions that benefit women who are poorer, less educated and live in rural areas.
Highlights
Despite major progress in reducing maternal mortality, it is unlikely that many low- and middle-income countries (LMICs) will be able to achieve their Millennium Development Goal (MDG) 5 target of reducing maternal mortality by 75-percent before 2015 [1,2]
The utilization of maternal care increased according to all three measures of maternal care between 1995 and 2010
It is evident that urban residents utilized more maternal care services compared to their rural counterparts for all indicators and in all years, as shown by the estimated urban–rural rate ratios
Summary
Despite major progress in reducing maternal mortality, it is unlikely that many low- and middle-income countries (LMICs) will be able to achieve their Millennium Development Goal (MDG) 5 target of reducing maternal mortality by 75-percent before 2015 [1,2]. In spite of overall progress made in the maternal health sector, evidence suggests that there are pronounced social gradients in utilization of key maternal care services and maternal health outcomes in Bangladesh [14,16,17]. Notwithstanding the significant progress in reducing maternal mortality in recent years, social inequalities in the utilization of maternal care continue to be a challenge in Bangladesh. We aim to provide a comprehensive analysis of trends in social inequalities in utilization of antenatal care (ANC), facility based delivery (FBD), and skilled birth attendance (SBA) in Bangladesh between 1995 and 2010
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