Skip to main content Accessibility help
×
Home
Hostname: page-component-59b7f5684b-z9m8x Total loading time: 0.515 Render date: 2022-09-29T08:35:12.776Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA

Published online by Cambridge University Press:  30 October 2017

Srinivas Goli*
Affiliation:
Population Studies, Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, India
Dipty Nawal
Affiliation:
CARE Patna, Bihar, India
Anu Rammohan
Affiliation:
Department of Economics, The University of Western Australia (M251), Crawley, Australia
T. V. Sekher
Affiliation:
Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
Deepshikha Singh
Affiliation:
Population Studies, Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, India
*
1Corresponding author. Email: sirispeaks2u@gmail.com

Summary

The gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010–11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of −0.1147, −0.1146, −0.2859 and −0.0638 for <3 antenatal care visits; CI of −0.1338, −0.0925, −0.1960 and −0.2531 for non-institutional delivery; and CI of −0.1153, −0.0370, −0.1817 and −0.0577 for no postnatal care within 2 days of delivery for Bangladesh, Ethiopia, Nepal and Zimbabwe, respectively. The marginal effects suggested that the strength of the association between the outcome and explanatory factors varied across the different countries. Decomposition estimates revealed that the key contributing factors for socioeconomic inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.

Type
Research Article
Copyright
© Cambridge University Press, 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alam, N., Hajizadeh, M., Dumont, A. & Fournier, P. (2015) Inequalities in maternal health care utilisation in sub-Saharan African countries: a multiyear and multi-country analysis. PLoS One 10(4), e0120922.CrossRefGoogle Scholar
Amano, A., Gebeyehu, A. & Birhanu, Z. (2012) Institutional delivery service utilisation in Munisa Woreda, South East Ethiopia: a community based cross-sectional study. BMC Pregnancy and Childbirth 12(1), 105.CrossRefGoogle Scholar
Amin, R., Shah, N. M. & Becker, S. (2010) Socioeconomic factors differentiating maternal and child health-seeking behaviour in rural Bangladesh: a cross-sectional analysis. International Journal for Equity in Health 9(1), 9.CrossRefGoogle ScholarPubMed
Anwar, I., Sami, M., Akhtar, N., Chowdhury, M. E., Salma, U., Rahman, M. & Koblinsky, M. (2008) Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programmes in Bangladesh. Bulletin of the World Health Organization 86(4), 252259.CrossRefGoogle ScholarPubMed
Braveman, P. A., Cubbin, C., Egerter, S., Chideya, S., Marchi, K. S., Metzler, M. & Posner, S. (2005) Socioeconomic status in health research: one size does not fit all. Journal of the American Medical Association 294(22), 28792888.CrossRefGoogle ScholarPubMed
Çalışkan, Z., Dilek, K., Selcen, Ö. & Emre, A. (2015) Equity in maternal health care service utilisation: a systematic review for developing countries. International Journal of Public Health 60(7), 815825.CrossRefGoogle Scholar
Central Statistical Agency & ICF International (2012) Ethiopia Demographic and Health Survey 2011. Central Statistical Agency, Addis Ababa, Ethiopia and ICF International, Calverton, MD, USA.Google Scholar
Chakraborty, N., Islam, M. A., Chowdhury, R. I., Bari, W. & Akhter, H. H. (2003) Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International 18(4), 327337.CrossRefGoogle ScholarPubMed
Choudhury, N. & Syed, M. A. (2011) Maternal care practices among the ultra poor households in rural Bangladesh: a qualitative exploratory study. BMC Pregnancy and Childbirth 11(1), 15.CrossRefGoogle ScholarPubMed
Coburn, D. & Coburn, E. (2007) Health and health inequalities in a neo-liberal global world. In McIntyre, D. & Mooney, G., (eds) The Economics of Health Equity. Cambridge University Press, Cambridge, pp. 1335.CrossRefGoogle Scholar
Countdown Coverage Writing Group (2008) Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. The Lancet 371, 12471258.CrossRefGoogle Scholar
Dhakal, S., Chapman, G. N., Simkhada, P. P., Van Teijlingen, E. R., Stephens, J. & Raja, A. E. (2007) Utilisation of postnatal care among rural women in Nepal. BMC Pregnancy and Childbirth 7(1), 19.CrossRefGoogle ScholarPubMed
Ethiopia Central Statistical Agency [ECSA] & ICF International (2012) Ethiopia Demographic and Health Survey 2011: Key Findings. CSA and ICF International, Calverton, MD, USA.Google Scholar
Filippi, V., Ronsmans, C., Campbell, O. M., Graham, W. J., Mills, A., Borghi, J. & Osrin, D. (2006) Maternal health in poor countries: the broader context and a call for action. The Lancet 368(9546), 15351541.CrossRefGoogle Scholar
Gaudin, S. & Yazbeck, A. S. (2006) Immunisation in India 1993–1999: wealth, gender, and regional inequalities revisited. Social Science & Medicine 62(3), 694706.CrossRefGoogle ScholarPubMed
Goland, E., Hoa, D. T. P. & Målqvist, M. (2012) Inequity in maternal health care utilisation in Vietnam. International Journal for Equity in Health 11(1), 24.CrossRefGoogle Scholar
Goldie, S. J., Sweet, S., Carvalho, N., Natchu, U. C. M. & Hu, D. (2010) Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis. PLoS Medicine 7(4), e1000264.CrossRefGoogle ScholarPubMed
Goli, S. & Arokiasamy, P. (2014a) Maternal and child mortality indicators across 187 countries of the world: converging or diverging. Global Public Health 9(3), 342360.CrossRefGoogle ScholarPubMed
Goli, S. & Arokiasamy, P. (2014b) Trends in health and health inequalities among major states of India: assessing progress through convergence models. Health Economics, Policy and Law 9(02), 143168.CrossRefGoogle ScholarPubMed
Goli, S., Doshi, R. & Perianayagam, A. (2013) Pathways of economic inequalities in maternal and child health in urban India: a decomposition analysis. PLoS One 8(3), e58573.CrossRefGoogle ScholarPubMed
Goli, S. & Jaleel, A. (2014) What cause the decline in maternal mortality in India? Evidence from time series and cross-sectional analyses. Journal of Biosocial Science 46(3), 351365.CrossRefGoogle ScholarPubMed
Goodburn, E. & Campbell, O. (2001) Reducing maternal mortality in the developing world: sector-wide approaches may be the key. British Medical Journal 322(7291), 917920.CrossRefGoogle ScholarPubMed
Graham, W. J., Ahmed, S., Stanton, C., Abou-Zahr, C. L. & Campbell, O. M. (2008) Measuring maternal mortality: an overview of opportunities and options for developing countries. BMC Medicine 6(1), 12.CrossRefGoogle ScholarPubMed
Hill, K., Thomas, K., AbouZahr, C., Walker, N., Say, L. & Inoue, M., & Maternal Mortality Working Group (2007) Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. The Lancet 370(9595), 13111319.CrossRefGoogle ScholarPubMed
Hogan, M. C., Foreman, K. J., Naghavi, M., Ahn, S. Y., Wang, M., Makela, S. M. & Murray, C. J. (2010a) Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. The Lancet 375(9726), 16091623.CrossRefGoogle ScholarPubMed
Hogan, M. C., Lopez, A. D., Lozano, R., Murray, C. J., Naghavi, M., Rajaratnam, J. K. & Foreman, K. J. (2010b) Building Momentum: Global Progress toward Reducing Maternal and Child Mortality. Institute for Health Metric Evaluation, University of Washington, USA.Google Scholar
Hopkins, S. (2010) Health expenditure comparisons: low, middle and high income countries. Open Health Services and Policy Journal 3(1), 111117.CrossRefGoogle Scholar
Hosseinpoor, A. R., Mohammad, K., Majdzadeh, R., Naghavi, M., Abolhassani, F., Sousa, A. & Vega, J. (2005) Socioeconomic inequality in infant mortality in Iran and across its provinces. Bulletin of the World Health Organization 83(11), 837844.Google ScholarPubMed
Houweling, T. A., Ronsmans, C., Campbell, O. M. & Kunst, A. E. (2007) Huge poor–rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bulletin of the World Health Organization 85(10), 745754.CrossRefGoogle ScholarPubMed
Joshi, C., Torvaldsen, S., Hodgson, R. & Hayen, A. (2014) Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. BMC Pregnancy and Childbirth 14(1), 94.CrossRefGoogle ScholarPubMed
Kakwani, N., Wagstaff, A. & Van Doorslaer, E. (1997) Socioeconomic inequalities in health: measurement, computation, and statistical inference. Journal of Econometrics 77(1), 87103.CrossRefGoogle Scholar
Kambarami, R. A., Chirenje, M. Z. & Rusakaniko, S. (1999) Antenatal care patterns and factors associated with perinatal outcome in two rural districts in Zimbabwe. Central African Journal of Medicine 45(11), 294299.Google ScholarPubMed
Kawachi, I., Subramanian, S. V. & Almeida-Filho, N. (2002) A glossary for health inequalities. Journal of Epidemiology and Community Health 56(9), 647652.CrossRefGoogle ScholarPubMed
Kevany, S., Murima, O., Singh, B., Hlubinka, D., Kulich, M., Morin, S. F. & Sweat, M. (2012) Socioeconomic status and health care utilisation in rural Zimbabwe: findings from Project Accept (HPTN 043). Journal of Public Health in Africa 3(1), 46.CrossRefGoogle Scholar
Kondo, N., Sembajwe, G., Kawachi, I., van Dam, R. M., Subramanian, S. V. & Yamagata, Z. (2009) Income inequality, mortality, and self-rated health: the meta-analysis of multilevel studies. British Medical Journal 339, b4471.CrossRefGoogle ScholarPubMed
McTavish, S., Moore, S., Harper, S. & Lynch, J. (2010) National female literacy, individual socioeconomic status, and maternal health care use in sub-Saharan Africa. Social Science & Medicine 71(11), 19581963.CrossRefGoogle ScholarPubMed
Marmot, M., Allen, J., Bell, R. & Goldblatt, P. (2012) Building of the global movement for health equity: from Santiago to Rio and beyond. The Lancet 379(9811), 181188.CrossRefGoogle ScholarPubMed
Matsumura, M. & Gubhaju, B. (2001) Women’s status, household structure and the utilisation of maternal health services in Nepal: even primary-leve1 education can significantly increase the chances of a woman using maternal health care from a modem health facility. Asia-Pacific Population Journal 16(1), 2344.CrossRefGoogle Scholar
Mazambani, D., Chigusiwa, L., Mudavanhu, V., Bindu, S. & Muchabaiwa, L. (2012) Determinants of maternal healthcare utilisation in Zimbabwe. International Journal of Economic Sciences and Applied Research 2, 145162.Google Scholar
Mekonnen, Y. & Mekonnen, A. (2003) Factors influencing the use of maternal healthcare services in Ethiopia. Journal of Health, Population and Nutrition 21(4), 374382.Google ScholarPubMed
Ministry of Health and Population, New ERA & ICF International (2011) Nepal Demographic and Health Survey 2011. Ministry of Health and Population and New ERA, Kathmandu. Nepal and ICF International, Calverton, MD, USA.Google Scholar
Moyer, C. A. & Mustafa, A. (2013) Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review. Reproductive Health 10(1), 40.CrossRefGoogle ScholarPubMed
Nawal, D. & Goli, S. (2013a) Inequalities in utilization of maternal health care services in Nepal. Ethnicity and Inequalities in Health and Social Care 6(1), 315.CrossRefGoogle Scholar
Nawal, D. & Goli, S. (2013b) Birth preparedness and its effect on place of safe delivery and care in Nepal. PLoS One. doi: 10.1371/journal.pone.0060957.CrossRefGoogle Scholar
NIPORT, Mitra, and Associates & ICF International (2013) Bangladesh Demographic and Health Survey 2011. National Institute of Population Research and Training (NIPORT) and Mitra and Associates, Dhaka, Bangladesh and ICF International, Calverton, MD, USA.Google Scholar
O’Donnell, O., Van Doorslaer, E., Wagstaff, A. & Lindelow, M. (2008) Analysing Health Equity Using Household Survey Data. World Bank, Washington, DC.Google Scholar
Price, N. & Pokharel, D. (2005) Using key informant monitoring in safe motherhood programming in Nepal. Development in Practice 15(2), 151164.CrossRefGoogle Scholar
Pulok, M. H., Sabah, M. N. U., Uddin, J. & Enemark, U. (2016) Progress in the utilisation of antenatal and delivery care services in Bangladesh: where does the equity gap lie? BMC Pregnancy and Childbirth 16(1), 200.CrossRefGoogle Scholar
Ronsmans, C., Graham, W. J. & Lancet Maternal Survival Series Steering Group (2006) Maternal mortality: who, when, where, and why. The Lancet 368(9542), 11891200.Google Scholar
Rowe, M. L., Thapa, B. K., Levine, R., Levine, S. & Tuladhar, S. K. (2005) How does schooling influence maternal health practices? Evidence from Nepal. Comparative Education Review 49(4), 512533.CrossRefGoogle Scholar
Rutstein, S. O. & Rojas, G. (2006) Guide to DHS Statistics. ORC Macro, Calverton, MD, USA.Google Scholar
Say, L. & Raine, R. (2007) A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bulletin of the World Health Organization 85(10), 812819.CrossRefGoogle Scholar
Stephenson, R., Baschieri, A., Clements, S., Hennink, M. & Madise, N. (2006) Contextual influences on the use of health facilities for childbirth in Africa. American Journal of Public Health 96(1), 8493.CrossRefGoogle ScholarPubMed
Subramanian, S. V. & Ertel, K. (2009) Author’s response self-rated health may be adequate for broad assessments of social inequalities in health. International Journal of Epidemiology 38(1), 319320.CrossRefGoogle Scholar
Subramanian, S. V., Nandy, S., Irving, M., Gordon, D., Lambert, H. & Davey Smith, G. (2006) The mortality divide in India: the differential contributions of gender, caste, and standard of living across the life course. American Journal of Public Health 96(5), 818825.CrossRefGoogle ScholarPubMed
Teferra, A. S., Alemu, F. M. & Woldeyohannes, S. M. (2012) Institutional delivery service utilisation and associated factors among mothers who gave birth in the last 12 months in Sekela District, North West of Ethiopia: A community-based cross-sectional study. BMC Pregnancy and Childbirth 12(1), 74.CrossRefGoogle Scholar
Tura, G. (2009) Antenatal care service utilisation and associated factors in Metekel Zone, Northwest Ethiopia. Ethiopian Journal of Health Sciences 19(2), 111119.Google Scholar
United Nations (2012) Goal 5 Maternal Health Fact Sheet. United Nations Summit high-level plenary meeting of the General Assembly, New York.Google Scholar
United Nations (2015) Goal 5 Improve Maternal Health. United Nations Summit high-level plenary meeting of the General Assembly, New York.Google Scholar
van Bon-Martens, M. J., Denollet, J., Kiemeney, L. A., Droomers, M., de Beer, M. J., van de Goor, I. A. & van Oers, H. A. (2012) Health inequalities in the Netherlands: a cross-sectional study of the role of Type D (distressed) personality. BMC Public Health 12(1), 46.CrossRefGoogle ScholarPubMed
Wagle, R. R., Sabroe, S. & Nielsen, B. B. (2004) Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal. BMC Pregnancy and Childbirth 4(1), 8.CrossRefGoogle ScholarPubMed
Wagstaff, A. (2002a) Inequalities in Health in Developing Countries: Swimming Against the Tide? World Bank Publications No. 2795.Google Scholar
Wagstaff, A. (2002b) Poverty and health sector inequalities. Bulletin of the World Health Organization 80(2), 97105.Google ScholarPubMed
Wagstaff, A., Paci, P. & Van Doorslaer, E. (1991) On the measurement of inequalities in health. Social Science & Medicine 33(5), 545557.CrossRefGoogle ScholarPubMed
Wagstaff, A. & Van Doorslaer, E. (2003) Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Economics 12(11), 921933.CrossRefGoogle ScholarPubMed
Wagstaff, A., Van Doorslaer, E. & Watanabe, N. (2003) On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. Journal of Econometrics 112(1), 207223.CrossRefGoogle Scholar
WHO, UNICEF, UNFPA & World Bank (2015) The World Trends in Maternal Mortality: 1990 to 2013. World Health Organization, Geneva.Google Scholar
Wilunda, C., Quaglio, G., Putoto, G., Takahashi, R., Calia, F., Abebe, D. & Atzori, A. (2015) Determinants of utilisation of antenatal care and skilled birth attendant at delivery in South West Shoa Zone, Ethiopia: a cross-sectional study. Reproductive Health 12(1), 74.Google Scholar
WHO (2014) World Health Organization Global Health Expenditure Database 1995–2014. World Health Organization, Geneva.Google Scholar
Yadamsuren, B., Merialdi, M., Davaadorj, I., Requejo, J. H., Betrán, A. P., Ahmad, A. & Hagan, R. (2010) Tracking maternal mortality declines in Mongolia between 1992 and 2007: the importance of collaboration. Bulletin of the World Health Organization 88(3), 192198.CrossRefGoogle ScholarPubMed
Zere, E., Tumusiime, P., Walker, O., Kirigia, J., Mwikisa, C. & Mbeeli, T. (2010) Inequities in the utilisation of maternal health interventions in Namibia: implications for progress towards MDG 5 targets. International Journal for Equity in Health 9(1), 16.CrossRefGoogle Scholar
ZIMSTAT & ICF International (2012) Zimbabwe Demographic and Health Survey 2010–11. Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International Inc., Calverton, MD, USA.Google Scholar
17
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *