Limwattananon Supon, Tangcharoensathien Viroj, Sirilak Supakit
Khon Kaen University, Khon Kaen, Thailand.
Reprod Health Matters. 2011 May;19(37):75-85. doi: 10.1016/S0968-8080(11)37564-7.
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.
在低收入国家，机构分娩的覆盖率较低。本研究利用25个低收入国家最近两次人口与健康调查（1995 - 2001年和2001 - 2006年）的数据，考察了妇女分娩地点的趋势——公立或私立机构还是非机构场所。在10个国家，超过一半的分娩在机构场所进行，大部分是在公立机构。在其他15个国家，大多数分娩是在妇女家中，这往往是她们唯一的选择。在两个调查期之间，所有5个接受研究的亚洲国家（除孟加拉国）的机构分娩覆盖率提高了10 - 20个百分点，而19个撒哈拉以南非洲国家中没有一个国家的增幅超过10个百分点。与农村和最贫困五分之一人口的妇女相比，城市妇女以及最富裕（最不贫困）五分之一人口中的妇女在公立或私立机构分娩的比例更高。机构分娩的贫富差距大于城乡差距。农村地区卫生系统基础设施的公共投资不足以及缺乏专业卫生人员是降低孕产妇死亡率的主要障碍。低收入国家的政府必须增加投资，特别是在农村孕产妇服务方面。加强私立营利性医疗机构并非贫困农村社区的政策选择。
