Inequity in maternal health care utilization in Vietnam

Abstract

IntroductionVietnam has succeeded in reducing maternal mortality in the last decades. Analysis of survey data however indicate that large inequities exist between different segments of the population. We have analyzed utilization of antenatal care and skilled birth attendance among Vietnamese women of reproductive age in relation to social determinants with the aim to reveal health inequities and identify disadvantaged groups.MethodData on maternal health care utilization and social determinants were derived from the Multiple Indicator Cluster Survey (MICS) conducted in Vietnam in 2006, and analyzed through stratified logistic regressions and g-computation.ResultsInequities in maternal health care utilization persist in Vietnam. Ethnicity, household wealth and education were all significantly associated with antenatal care coverage and skilled birth attendance, individually and in synergy. Although the structural determinants included in this study were closely related to each other, analysis revealed a significant effect of ethnicity over and above wealth and education. Within the group of mothers from poor households ethnic minority mothers were at a three-fold risk of not attending any antenatal care (OR 3.06, 95% CI 1.27–7.41) and six times more likely not to deliver with skilled birth attendance (OR 6.27, 95% CI 2.37–16.6). The association between ethnicity and lack of antenatal care and skilled birth attendance was even stronger within the non-poor group.ConclusionsIn spite of policies to out rule health inequities, ethnic minority women constitute a disadvantaged group in Vietnam. More efficient ways to target disadvantaged groups, taking synergy effects between multiple social determinants into consideration, are needed in order to assure safe motherhood for all.

Individual and Contextual Determinants of Adequate Maternal Health Care Services in Kenya

“…Women of the Kamba and Luhya ethnic descent were, generally, less likely to use MHC services compared with women of Kikuyu descent. Similar findings suggesting that belonging to an ethnic minority group is a risk factor in itself are pervasive in the literature (Goland, Hoa, and Målqvist 2012;LaVeist and Isaac 2012;Målqvist et al 2013). …”

Maternal health care utilization in Viet Nam: increasing ethnic inequity

“…15,16 In a previous paper we used data from the MICS3 survey conducted in 2006 to report on these differences in maternal health care utilization, particularly in antenatal care and skilled birth attendance. 17 Data from MICS4, conducted in 2010-2011, is now available. The rapid social development that has taken place in Viet Nam in recent years makes it important to examine changes in the equity gap linked to antenatal care attendance and delivery in health facilities.…”

Inequalities in utilization of maternal health care services in Nepal

“…After reviewing extensive list of health inequality studies (e.g. Wagstaff and van Doorslaer, 1991;Kakwani et al, 1997;Wagstaff, 2002a, b;Kawachi et al, 2002;Wagstaff et al, 2003;Rowe et al, 2005;Subramanian et al, 2006;Subramanian and Ertel, 2009;Konda et al, 2009;Goland et al, 2012;van Bon-Martens et al, 2012), we have selected few critical socioeconomic predictors of maternal health to carrying out decomposition analyses. The detailed descriptions of the selected socioeconomic variables are given below.…”

“…Wagstaff and van Doorslaer, 1991;Kakwani et al, 1997;Gwatkin, 2000;Kawachi et al, 2002;Wagstaff, 2002a, b;Marmot, 2002;Wagstaff et al, 2003;Subramanian and Kawachi, 2004;Hosseinpoor et al, 2006;Subramanian et al, 2006;Subramanian and Ertel, 2009;Harper and Lynch, 2007;Van de Poel et al, 2008;Subramanian, 2008;Speybroeck et al, 2010;Konda et al, 2009;Po and Subramanian, 2010;Marmot, 2005Marmot, , 2010Subramanyam and Subramanian, 2011;Goland et al, 2012;van Bon-Martens et al, 2012;Jain et al, 2012;Tonoyan and Lusine, 2012;Suzuki et al, 2005;.…”