Abstract
BackgroundMaternal health affects the lives of many women and children globally every year and it is one of the high priority programs of the Government of Nepal (GoN). Different evidence articulate that the equity gap in accessing and using maternal health services at national level is decreasing over 2001–2016. This study aimed to assess whether the equity gap in using maternal health services is also decreasing at subnational level over this period given the geography of Nepal has already been identified as one of the predictors of accessibility and utilization of maternal health services.MethodsThe study used wealth index scores for each household and calculated the concentration curves and indexes in their relative formulation, with no corrections. Concentration curve was used to identify whether socioeconomic inequality in maternity services exists and whether it was more pronounced at one point in time than another or in one province than another. The changes between 2001 and 2016 were also disaggregated across the provinces. Test of significance of changes in Concentration Index was performed by calculating pooled standard errors. We used R software for statistical analysis.ResultsThe study observed a progressive and statistically significant decrease in concentration index for at least four antenatal care (ANC) visit and institutional delivery at national level over 2001–2016. The changes were not statistically significant for Cesarean Section delivery. Regarding inequality in four-ANC all provinces except Karnali showed significant decreases at least between 2011 and 2016. Similarly, all provinces, except Karnali, showed a statistically significant decrease in concentration index for institutional delivery between 2011 and 2016.ConclusionDespite appreciable progress at national level, the study found that the progress in reducing equity gap in use of maternal health services is not uniform across seven provinces. Tailored investment to address barriers in utilization of maternal health services across provinces is urgent to make further progress in achieving equitable distribution in use of maternal health services. There is an opportunity now that the country is federalized, and provincial governments can make a need-based improvement by addressing specific barriers.
Highlights
Maternal health affects the lives of many women and children globally every year and it is one of the high priority programs of the Government of Nepal (GoN)
Despite appreciable progress at national level, the study found that the progress in reducing equity gap in use of maternal health services is not uniform across seven provinces
An assessment conducted by the Ministry of Health and Population has shown that demand side financing in Nepal was associated with an increase in uptake of maternal health services such as institutional delivery [17, 42]
Summary
Maternal health affects the lives of many women and children globally every year and it is one of the high priority programs of the Government of Nepal (GoN). Inequalities in access to care for vulnerable populations; poor quality of available care; grave deficiencies in health system infrastructure and workforce; and the impact of economic, political, sociodemographic and environmental factors all contribute significantly to the risk of poor maternal health outcomes and hinder progress toward reduction in mortality and morbidity [4,5,6,7,8,9]. In this situation, attaining the sustainable development goal (SDG) will not be possible without reducing the burden of the deprived in all population subgroups
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