Inequities in postnatal care in low- and middle-income countries: a systematic review and meta-analysis

Abstract

ObjectiveTo assess the socioeconomic, geographical and demographic inequities in the use of postnatal health-care services in low- and middle-income countries.MethodsWe searched Medline, Embase and Cochrane Central databases and grey literature for experimental, quasi-experimental and observational studies that had been conducted in low- and middle-income countries. We summarized the relevant studies qualitatively and performed meta-analyses of the use of postnatal care services according to selected indicators of socioeconomic status and residence in an urban or rural setting.FindingsA total of 36 studies were included in the narrative synthesis and 10 of them were used for the meta-analyses. Compared with women in the lowest quintile of socioeconomic status, the pooled odds ratios for use of postnatal care by women in the second, third, fourth and fifth quintiles were: 1.14 (95% confidence interval, CI : 0.96–1.34), 1.32 (95% CI: 1.12–1.55), 1.60 (95% CI: 1.30–1.98) and 2.27 (95% CI: 1.75–2.93) respectively. Compared to women living in rural settings, the pooled odds ratio for the use of postnatal care by women living in urban settings was 1.36 (95% CI: 1.01–1.81). A qualitative assessment of the relevant published data also indicated that use of postnatal care services increased with increasing level of education.ConclusionIn low- and middle-income countries, use of postnatal care services remains highly inequitable and varies markedly with socioeconomic status and between urban and rural residents.

Place of Delivery Associated With Postnatal Care Utilization Among Childbearing Women in Zambia

“…It was also established that there was reduced likelihood of PNC utilization by women living in rural areas compared to those in urban areas which could be attributed to many factors including distance from health facilities (16), cultural practices, or myths and beliefs. For instance, there are cultural practices which prevent recently delivered mothers and newborn to be touched by any one or leave the house until the 12th day after delivery (17) and have been associated with non utilization of PNC (18).…”

Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

“…Our search terms were adopted from previous studies (20, 21). Although it may not cover all words used in PROGRESS+ elements, we believe that, it is specific to the outcome and exposures of interest.…”

“…The main terms for literature search included ‘Diabetes’, ‘Medication’, ‘Social determinant’, and ‘Low- and middle-income countries’. We adopted the search terms for ‘Medication’, ‘Social determinants’ and ‘Low- and middle-income countries’ from previously published systematic reviews (20, 21). Table 1 gives further details on the terms used in the literature search.…”

Postnatal care: increasing coverage, equity, and quality

“…Eff orts to mitigate inequities in transport to facilities, such as bus and voucher schemes, have shown eff ectiveness in improving equity of access. 12 Yet more eff ort and investment is needed in ensuring services for all are accessible and high quality.…”