International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
Bull World Health Organ. 2013 Apr 1;91(4):254-61. doi: 10.2471/BLT.12.112425. Epub 2013 Feb 13.
To investigate changes that took place between 2006 and 2010 in the inequity gap for antenatal care attendance and delivery at health facilities among women in Viet Nam.
Demographic, socioeconomic and obstetric data for women aged 15-49 years were extracted from Viet Nam's Multiple Indicator Cluster Survey for 2006 (MICS3) and 2010-2011 (MICS4). Multivariate logistic regression was performed to determine if antenatal care attendance and place of delivery were significantly associated with maternal education, maternal ethnicity (Kinh/Hoa versus other), household wealth and place of residence (urban versus rural). These independent variables correspond to the analytical framework of the Commission on Social Determinants of Health.
Large discrepancies between urban and rural populations were found in both MICS3 and MICS4. Although antenatal care attendance and health facility delivery rates improved substantially between surveys (from 86.3 to 92.1% and from 76.2 to 89.7%, respectively), inequities increased, especially along ethnic lines. The risk of not giving birth in a health facility increased significantly among ethnic minority women living in rural areas. In 2006 this risk was nearly five times higher than among women of Kinh/Hoa (majority) ethnicity (odds ratio, OR: 4.67; 95% confidence interval, CI: 2.94-7.43); in 2010-2011 it had become nearly 20 times higher (OR: 18.8; 95% CI: 8.96-39.2).
Inequity in maternal health care utilization has increased progressively in Viet Nam, primarily along ethnic lines, and vulnerable groups in the country are at risk of being left behind. Health-care decision-makers should target these groups through affirmative action and culturally sensitive interventions.
调查 2006 年至 2010 年间越南妇女在卫生机构接受产前保健和分娩服务的公平差距发生的变化。
从越南 2006 年（MICS3）和 2010-2011 年（MICS4）多指标类集调查中提取了 15-49 岁妇女的人口统计学、社会经济和产科数据。采用多变量逻辑回归来确定产前保健和分娩地点是否与产妇教育、产妇民族（京族/华族与其他民族）、家庭财富和居住地（城市与农村）显著相关。这些自变量对应于卫生保健决定因素委员会的分析框架。
在 MICS3 和 MICS4 中，城乡人口之间存在很大差异。尽管产前保健和在卫生机构分娩的比例在两次调查中都有大幅提高（从 86.3%提高到 92.1%和从 76.2%提高到 89.7%），但不平等现象加剧了，尤其是在民族方面。生活在农村地区的少数民族妇女在卫生机构分娩的风险显著增加。2006 年，这一风险几乎是京族/华族（多数族裔）妇女的五倍（优势比，OR：4.67；95%置信区间，CI：2.94-7.43）；2010-2011 年，这一风险几乎增加了 20 倍（OR：18.8；95% CI：8.96-39.2）。
越南孕产妇保健利用方面的不公平现象逐渐加剧，主要是沿着民族线，该国的弱势群体面临被抛在后面的风险。医疗保健决策者应通过平权行动和具有文化敏感性的干预措施针对这些群体。
