Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People’s Democratic Republic from 2006 to 2017: MICS data analysis

Abstract

Background: Maternal mortalities remain high in Lao People’s Democratic Republic (Lao PDR). To improve access to maternal health services for all women, the country adopted a policy to remove user fees for childbirth-related care (“Free Maternal Health Service” [Free MCH] policy) in 2012. However, it remains unclear whether the policy has reduced inequalities in access to services. Our study assessed the trends and magnitude of sociodemographic and economic inequalities in access to health services before and after adoption of the Free MCH policy. Methods: We used the three most recent Lao Social Indicator Survey datasets for this analysis. We assessed wealth, area of residence, ethnicity, educational attainment, and women’s age-related inequalities in the use of at least one antenatal care (ANC) visit with skilled personnel, institutional delivery, and at least one facility-based postnatal care (PNC) visit by mothers. The magnitude of inequalities was measured using concentration curves, concentration indices (CIX), and equiplots. Results: Overall, the coverages of at least one ANC visit with skilled personnel and institutional delivery increased from 35.7% to 78.4% and 23.1% to 65.5% respectively, between the years 2006 and 2017. These coverages almost doubled in all social groups from 2011–12 to 2017 compared to 2006 to 2011–12. Meanwhile, the use of at least one facility-based PNC after discharge rose only from 2.3% to 3.7% between 2011–12 and 2017. Despite the decreases in service utilization gaps between groups, inequalities in favor of the rich, the most educated, and the majority ethnic groups remained the highest, particularly for facility-based deliveries. The CIX in 2017 were 0.193, 0.139, and 0.120, respectively, for these factors (p <0.001). Conclusion: During the study period, uptake of maternal health services improved, and sociodemographic and economic inequalities decreased. The highest improvement since adoption of the MCH policy occurred among the least-favored women. Future interventions should promote outreach services, awareness raising, and a woman-centered approach to care. More attention should also be given to improving the uptake of facility-based PNC visits.