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Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?

BACKGROUND: 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 evaluati...

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Autores principales: Pulok, Mohammad Habibullah, Sabah, Md Nasim-Us, Uddin, Jalal, Enemark, Ulrika
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967314/
https://www.ncbi.nlm.nih.gov/pubmed/27473150
http://dx.doi.org/10.1186/s12884-016-0970-4
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author Pulok, Mohammad Habibullah
Sabah, Md Nasim-Us
Uddin, Jalal
Enemark, Ulrika
author_facet Pulok, Mohammad Habibullah
Sabah, Md Nasim-Us
Uddin, Jalal
Enemark, Ulrika
author_sort Pulok, Mohammad Habibullah
collection PubMed
description BACKGROUND: 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. 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. METHODS: The 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. RESULTS: The 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. CONCLUSIONS: Bangladesh 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.
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spelling pubmed-49673142016-07-31 Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie? Pulok, Mohammad Habibullah Sabah, Md Nasim-Us Uddin, Jalal Enemark, Ulrika BMC Pregnancy Childbirth Research Article BACKGROUND: 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. 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. METHODS: The 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. RESULTS: The 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. CONCLUSIONS: Bangladesh 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. BioMed Central 2016-07-29 /pmc/articles/PMC4967314/ /pubmed/27473150 http://dx.doi.org/10.1186/s12884-016-0970-4 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Pulok, Mohammad Habibullah
Sabah, Md Nasim-Us
Uddin, Jalal
Enemark, Ulrika
Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?
title Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?
title_full Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?
title_fullStr Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?
title_full_unstemmed Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?
title_short Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?
title_sort progress in the utilization of antenatal and delivery care services in bangladesh: where does the equity gap lie?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967314/
https://www.ncbi.nlm.nih.gov/pubmed/27473150
http://dx.doi.org/10.1186/s12884-016-0970-4
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