Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh

Abstract

BackgroundDespite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children’s Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization.MethodTwo surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index.ResultsMean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370).ConclusionsOverall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups. Maternal health programs, if properly designed and implemented, can improve access, partially overcoming the negative effects of socioeconomic disparities.

Inequalities in Utilization of Maternal Reproductive Health Care Services in Urban Bangladesh: A Population-Based Study

“…Ensuring appropriate health care services for women amid a rapidly growing urban population is challenging. Limited studied have focused on the maternal health care inequalities (Haider et al, 2017;Mahabub-Ul-Anwar et al, 2006), particularly for urban women (Ahmed et al, 2005; M. M. H. Khan et al, 2011;Pulok et al, 2016). Moreover, most of the existing studies examining the inequalities adopted conventional regressions, which are not well-suited for estimating inequalities.…”

Barriers to access maternal health services among urban poor women in Bangladesh: A Case of Rajshahi City

“…[38][39][40][41][42][43][44] The Government of Bangladesh has taken many initiatives for reaching people's doorsteps with healthcare services since independence. [45][46][47][48] Other private and NGOs have also been trying to provide healthcare services at people's convenient places. All these endeavours have resulted in building healthcare service delivery centres and providing healthcare services at people's doorsteps.…”

Constraints to Get Access in Maternal Healthcare: A Review from Lower-middle-Income Countries

“…Wang, 2017;. The wealthier section can likewise more promptly manage the cost of services and the persevering out of pocket expense for specific deliveries and so more likely to get maternal health services (O. E. Dalinjong et al, 2018;Haider et al, 2017;Iacoella & Tirivayi, 2019;Koroma et al, 2017;McNamee et al, 2009;R. K. Rai et al, 2013;Wong et al, 2017;, these findings are also documented in the literature of Anyait et al (2012), Kitui et al (2013), Ononokpono and Azfredrick (2014) and Shahjahan et al (2017).…”

“…The decision of taking healthcare services is implanted and interweaved not only with social and cultural practices but also with the distance of the service provider institutions (Elmusharaf et al, 2015;McNamee et al, 2009;Walton & Schbley, 2013). The study of Blanchet et al (2012), Sahoo et al (2015) and unfold that the characteristics of the region like the doctor to population and nurse to population ratio along with feeble infrastructure, distance, fragile transportation making the health service to be utilized, particularly for the vulnerable groups living with limited medical resource facilities (Ambel et al, 2017;Faye et al, 2013;Gage, 2007;Haider et al, 2017;McKinnon et al, 2016;Shahjahan et al, 2017;. In the Ethiopian context, the distance between house and health service provider organizations had an impact on the use of maternal service including ANC, delivery, and PNC.…”