Socioeconomic inequalities and determinants of maternal health services in Shaanxi Province, Western China

Abstract

Prenatal health care interventions are effective ways to improve maternal and neonatal health. There have been few large investigations conducted on the inequalities in maternal health services utilization in Shaanxi Province of west China since the health care reform in 2009. This study examined the inequalities and determinants of maternal health services utilization in Shaanxi Province. A household survey was conducted from August to November in 2013. By using a multistage sampling method, local women aged 15–49 who had given birth in the preceding three years were recruited. Information including social-demographic characteristics and maternal health services utilization was collected through a face-to-face interview. A concentration index approach was used to measure inequalities in maternal health services utilization. A logistic regression model was employed to investigate the determinants of maternal health services utilization. There were 8,488 women from urban areas and 18,724 women from rural areas enrolled in this study. The concentration index for all the indicators of maternal health services utilization showed significance in these two areas. In urban areas, the concentration index of having 5 or more prenatal visits, receiving the first prenatal visit within 12 weeks, delivering at secondary- or higher-level health facilities and delivering by C-section were 0.0356, 0.0166, 0.0177 and 0.0591, respectively, while in rural areas, the corresponding figures were 0.0385, 0.0183, 0.0334 and 0.0566, respectively. The determinants related to maternal health services utilization were women’s age at delivery, educational level, employment status, parity, health problems during pregnancy and household income. Inequalities in maternal health services utilization still exist in Shaanxi Province. Providing maternal health services for younger, less educated, unemployed, high parity and poorer women, especially in rural areas, is expected to reduce the inequalities in maternal health services utilization.

Socioeconomic status inequity in inpatient service utilization based on need among migrants: Evidence from a national study in China

“…Although previous studies have shown that high-SES is a protective factor in using public health service among the migrants [12,16,17,[47][48][49], few explored from the perspective of inpatient services need among internal migrants in China. The present study also has several limitations.…”

Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: Evidence from two cross-sectional household surveys in Shaanxi Province

“…In China existing research on the healthcare reform impacts primarily focuses on prenatal visits, hospital delivery or postnatal visits separately. Recent studies have evaluated socio-economic inequalities and found socioeconomic determinants of prenatal and postnatal visits [17][18][19], explored influence of health policy on improving the utilisation of hospital delivery [20], prenatal or postnatal visits [21], fewer studies explore the utilisation of CMHS. To date, there has been some research exploring the determinants, effects, value, measurement of CMHS in LMICs outside of China: in Lao PDR [22], Nepal [23], Tanzania [10], South Africa [11], Cambodia [24].…”

How internal migrants’ socioeconomic status affect their unmet inpatient service need? Evidence from a national study in China

“…The major contribution of this study was that we sought to identify the relationship between individual's SES and unmet inpatient service among internal migrants. Although previous studies have shown that high-SES is a protective factor in using public health service among the migrants [9,15,17,19,38,39], but few studies have explored the association between SES and unmet inpatient services among internal migrants in China. However, this study also had several limitations.…”