Abstract
BackgroundIn Bangladesh, India and Nepal, neonatal outcomes of poor infants are considerably worse than those of better-off infants. Understanding how these inequalities vary by country and place of delivery (home or facility) will allow targeting of interventions to those who need them most. We describe socio-economic inequalities in newborn care in rural areas of Bangladesh, Nepal and India for all deliveries and by place of delivery.MethodsWe used data from surveillance sites in Bangladesh, India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used literacy (ability to read a short text) as indicator of socioeconomic status. We developed a composite score of nine newborn care practices (score range 0–9 indicating infants received no newborn care to all nine newborn care practices). We modeled the effect of literacy and place of delivery on the newborn care score and on individual practices.ResultsIn all study sites (60,078 deliveries in total), use of facility delivery was higher among literate mothers. In all sites, inequalities in newborn care were observed: the difference in new born care between literate and illiterate ranged 0.35–0.80. The effect of literacy on the newborn care score reduced after adjusting for place of delivery (range score difference literate-illiterate: 0.21–0.43).ConclusionSocioeconomic inequalities in facility care greatly contribute to inequalities in newborn care. Improving newborn care during home deliveries and improving access to facility care are a priority for addressing inequalities in newborn care and newborn mortality.
Highlights
In Bangladesh, India and Nepal, neonatal outcomes of poor infants are considerably worse than those of better-off infants
Uptake of facility delivery was substantially higher among literate women than among illiterate women
Uptake of newborn care practices varied strongly between individual practices, but was far from universal for most practices (Table 4)
Summary
In Bangladesh, India and Nepal, neonatal outcomes of poor infants are considerably worse than those of better-off infants. Understanding how these inequalities vary by country and place of delivery (home or facility) will allow targeting of interventions to those who need them most. In 2007 the DHS in Bangladesh began to collect data on newborn care with questions on the use of clean instruments to cut the umbilical cord, cord care, bathing delays and prevention of hypothermia [10]. In 2011, the DHS in Nepal began to collect similar data on newborn care, underscoring the importance of measuring improvements in newborn care practices to improve neonatal survival [11]. The DHS newborn care questions were asked to women who gave birth up to three years ago, which may result in recall bias
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