Inequity in maternal health-care services: Evidence from home-based skilled-birth-attendant programmes in Bangladesh

I. Anwar, M. Sami, N. Akhtar, M. E. Chowdhury, U. Salma, M. Rahman, M. Koblinsky

Research output: Contribution to journalArticle

Abstract

Objective: To explore use-inequity in maternal health-care services in home-based skilled-birth-attendant (SBA) programme areas in Bangladesh. Methods: Data from a community survey, conducted from February to May 2006, were analysed to examine inequities in use of SBAs, caesarean sections for deliveries and postnatal care services according to key socioeconomic factors. Findings: Of 2164 deliveries, 35% had an SBA, 22.8% were in health facilities and 10.8% were by caesarean section. Rates of uptake of antenatal and postnatal care were 93% and 28%, respectively. There were substantial use-inequities in maternal health by asset quintiles, distance, and area of residence, and education of both the woman and her husband. However, not all inequities were the same. After adjusting for other determinants, the differences in the use of maternal health-care services for poor and rich people remained substantial [adjusted odds ratio (OR) 2.51 (95% confidence interval, CI: 1.68-3.76) for skilled attendance; OR 2.58 (95% CI: 1.28-5.19) for use of caesarean sections and OR 1.53 (95% CI: 1.05-2.25) for use of postnatal care services]. Complications during pregnancy influenced use of SBAs, caesarean-section delivery and postnatal care services. The number of antenatal care visits was a significant predictor for use of SBAs and postnatal care, but not for caesarean sections. Conclusion: Use of maternity care services was higher in the study areas than national averages, but a tremendous use-inequity persists. Interventions to overcome financial barriers are recommended to address inequity in maternal health. A greater focus is needed on the implementation and evaluation of maternal-health interventions for poor people.

Original languageEnglish (US)
Pages (from-to)252-259
Number of pages8
JournalBulletin of the World Health Organization
Volume86
Issue number4
DOIs
StatePublished - Apr 2008
Externally publishedYes

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Maternal Health Services
Postnatal Care
Bangladesh
Cesarean Section
Parturition
Delivery of Health Care
Prenatal Care
Odds Ratio
Pregnancy Complications
Health Facilities
Spouses
Confidence Intervals
Education
Maternal Health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Inequity in maternal health-care services : Evidence from home-based skilled-birth-attendant programmes in Bangladesh. / Anwar, I.; Sami, M.; Akhtar, N.; Chowdhury, M. E.; Salma, U.; Rahman, M.; Koblinsky, M.

In: Bulletin of the World Health Organization, Vol. 86, No. 4, 04.2008, p. 252-259.

Research output: Contribution to journalArticle

Anwar, I. ; Sami, M. ; Akhtar, N. ; Chowdhury, M. E. ; Salma, U. ; Rahman, M. ; Koblinsky, M. / Inequity in maternal health-care services : Evidence from home-based skilled-birth-attendant programmes in Bangladesh. In: Bulletin of the World Health Organization. 2008 ; Vol. 86, No. 4. pp. 252-259.
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