Trends and inequities in where women delivered their babies in 25 low-income countries: evidence from Demographic and Health Surveys

Abstract

In low-income countries, the coverage of institutional births is low. Using data from the two most recent Demographic and Health Surveys (1995-2001 and 2001-2006) for 25 low-income countries, this study examined trends in where women delivered their babies--public or private facilities or non-institutional settings. More than half of deliveries were in institutional settings in ten countries, mostly public facilities. In the other 15 countries, the majority of births were in women's homes, which was often their only option. Between the two survey periods, all five Asian countries studied (except Bangladesh) had an increase of 10-20 percentage points in institutional coverage, whereas none of the 19 sub-Saharan African countries saw an increase of more than 10 percentage points. More urban women and more in the richest (least poor) quintile gave birth in public or private facilities than rural and poorest quintile women. The rich-poor gap of institutional births was wider than the urban-rural gap. Inadequate public investment in health system infrastructure in rural areas and lack of skilled health professionals are major obstacles in reducing maternal mortality. Governments in low-income countries must invest more, especially in rural maternity services. Strengthening private, for-profit providers is not a policy choice for poor, rural communities.

Persistent inequity in maternal health care utilization in Nepal despite impressive overall gains

“…These findings are in line with previous investigations of the distribution of health care utilization over time,[16,17] where improvements happen simultaneously in various groups in society. [18] The tendency for the health gains to be realized earlier in urban areas and among those of high socioeconomic status indicates a need for targeted interventions to reach the most disadvantaged and vulnerable.…”

The Rationale for Probiotics Improving Reproductive Health and Pregnancy Outcome

“…38 There are clearly inequities in low-income countries 39 with poor access to food, healthcare and appropriate interventions, and in those living in areas where external factors, such as pollution, are poorly controlled.…”

Sexual and reproductive health and rights in changing health systems

“…As suggested earlier, much of the literature on UHC and even the WHO definition above have not done well so far in recognising social determinants of inequality other than wealth/income (Commission on Social Determinants of Health, 2008). It is by now well known that inequality by gender, race/ethnicity, indigeneity, caste, disability and other status intersect with each other and with income/wealth to determine who suffers the greatest deficits, whether in health, education, employment, housing or any of the Millenium Development Goals (Ewig, 2010;Limwattananon et al, 2011;Ravindran & Nair, 2012;UNFPA, 2010).…”

“…However, these need to be matched by improvements in quality of services. There is growing evidence from community groups working on the ground in a number of countries that weaknesses in the availability of beds and personnel combined with insufficient training in the face of growing demand leads to a number of questionable practices: women are discharged from the labour wards too soon after delivery; practices during delivery include routine episiotomies, application of excessive fundal pressure, unecessary oxytocin injections and other practices meant to speed up the delivery; unnecessary caesarean sections become the norm; and poorly trained personnel are unable to recognise or manage obstetric emergencies before it becomes too late to save the life of the woman (Chopra et al, 2009;Limwattananon et al, 2011;Oladapo, Daniel, & Olatunji, 2006;Rashid et al, 2011;Wahed, Moran, & Iqbal, 2010). This has led to a growing discussion in Latin America of the incidence of the phenomenon of so-called 'obstetric violence' as a characterisation of the serious quality failures that may result.…”

“…However, even when financial and geographic barriers have been removed, acceptability (Govender & Penn-Kekana, 2008;Tilahun et al, 2012;Tylee, Haller, Graham, Churchill, & Sanci, 2007) and quality-of-care (Ahmed & Khan, 2011;Limwattananon, Tangcharoensathien, & Sirilak, 2011;Nguyen, Snider, Ravishankar, & Magvanjav, 2011;Ravindran & Nair, 2012) challenges can persist. SRH services, particularly those that are contested, are often the site where quality-of-care remains a challenge (Wood & Jewkes, 2006).…”