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    Trends and inequities in use of maternal health care services in Bangladesh, 1991-2011

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    Date
    2015
    Publisher
    © 2015 Public Library of Science
    Author
    Anwar, Iqbal
    Y. Nababan, Herfina
    Mostari, Shabnam
    Rahman, Aminur
    A. M. Khan, Jahangir
    Metadata
    Show full item record
    URI
    http://hdl.handle.net/10361/7411
    Citation
    Anwar, I., Nababan, H. Y., Mostari, S., Rahman, A., & Khan, J. A. M. (2015). Trends and inequities in use of maternal health care services in bangladesh, 1991-2011. PLoS ONE, 10(3) doi:10.1371/journal.pone.0120309
    Abstract
    Background and Methods Monitoring use-inequity is important to measure progress in efforts to address healthinequities. Using data from six Bangladesh Demographic and Health Surveys (BDHS), we examine trends, inequities and socio-demographic determinants of use of maternal health care services in Bangladesh between 1991 and 2011. Findings Access to maternal health care services has improved in the last two decades. The adjusted yearly trend was 9.0% (8.6%-9.5%) for any antenatal care (ANC), 11.9%(11.1%-12.7%) for institutional delivery, and 18.9% (17.3%-20.5%) for C-section delivery which is above the WHO recommended rate of 5-15%. Use-inequity was significant for all three indicators but is reducing over time. Between 1991-1994 and 2007-2011 the rich:poor ratio reduced from 3.65 to 1.65 for ANC and from 15.80 to 6.77 for institutional delivery. Between 1995-1998 and 2007-2011, the concentration index reduced from 0.27 (0.25-0.29) to 0.15 (0.14-0.16) for ANC, and from 0.65 (0.60-0.71) to 0.39 (0.37-0.41) for institutional delivery during that period. For use of c-section, the rich:poor ratio reduced from 18.17 to 13.39 and the concentration index from 0.66 (0.57-0.75) to 0.47 (0.45-0.49). In terms of rich:poor differences, there was equity-gain for ANC but not for facility delivery or C-section delivery. All sociodemographic variables were significant predictors of use; of them, maternal education was the most powerful. In addition, the contribution of for-profit private sector is increasingly growing in maternal health. Conclusion Both access and equity are improving in maternal health. We recommend strengthening ongoing health and non-health interventions for the poor. Use-inequity should be monitored using multiple indicators which are incorporated into routine health information systems. Rising C-section rate is alarming and indication of C-sections should be monitored both in private and public sector facilities.
    Keywords
    Bangladesh; Health care access; Health survey; Maternal care; Maternal welfare; Medical service; Prenatal care; Social status; Vaginal delivery
     
    Description
    This article was published in PLoS ONE [© 2015 Public Library of Science] and the definite version is available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120309
    Publisher Link
    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120309
    DOI
    http://doi.org/10.1371/journal.pone.0120309
    Department
    James P Grant School of Public Health, BRAC University
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