Shen Yuan, Yan Hong, Reija Klemetti, Li Qiang, Xiao Shengbin, Gao Jianmin, Zhou Zhongliang
Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710061, P,R, China.
BMC Health Serv Res. 2014 Apr 5;14:155. doi: 10.1186/1472-6963-14-155.
The 20th century was marked by a significant improvement in worldwide human health and access to healthcare. However, these improvements were not completely or uniformly distributed among, or even within, nations. This study was designed to assess the use of maternal health services by pregnant women in China, with a focus on the inequity related to family income level.
Two population-based cross-sectional surveys were carried out in the Zhenan and Lantian counties in March 2007 and from December 2008 to March 2009. A total of 2562 women completed the questionnaires, including 948 who were pregnant in 2006 and 1614 from 2008-2009. The concentration index (CI) was calculated and used to analyze the parameters of maternal health care in the two counties surveyed.
The responses in both 2006 and 2008-2009 indicated a bias towards higher (rich) economic statuses for the use of maternal and child health services. The CI of 'delivery at health facility' was 0.0206 (95% confidence interval between 0.0114 and 0.0299) for 2006 and 0.0053 (95% confidence interval between 0.0015 and 0.0091) for 2008, which represented a statistically significant inequity for women of lower (poor) economic statuses. Similar CI was observed in 'receiving antenatal care within 12 weeks' for 2006 (CI2006 = 0.0956, 95% confidence interval between 0.0516 and 0.1396). The CIs of 'postnatal visit' and 'postnatal visit >3-times' was positive (except for 2006), indicating that the poor used postnatal care less than the non-poor. In 2008, poor women had C-sections more often than non-poor women (CI2008 = -0.0629, 95% confidence interval between-0.1165 and -0.0093), but such a difference was not observed in 2006.
In 2006 and 2008, the use of maternal health services in western rural China was significantly unequal between pregnant women of poor and non-poor economic statuses. Financial support that enables poorer pregnant women to use health services will be beneficial. Utilization of maternal healthcare services can be improved if out-of-pocket expenses can be minimized.
20世纪全球人类健康状况及医疗服务可及性有显著改善。然而，这些改善在各国之间甚至各国国内的分布并不完全或均匀。本研究旨在评估中国孕妇对孕产妇保健服务的利用情况，重点关注与家庭收入水平相关的不平等问题。
2007年3月以及2008年12月至2009年3月期间，在镇安县和蓝田县开展了两项基于人群的横断面调查。共有2562名女性完成问卷，其中包括2006年怀孕的948名以及2008 - 2009年期间的1614名。计算集中指数（CI）并用于分析所调查的两个县孕产妇保健的各项参数。
2006年和2008 - 2009年的调查结果均表明，在利用母婴保健服务方面存在偏向较高（富裕）经济状况人群的倾向。2006年“在医疗机构分娩”的集中指数为0.0206（95%置信区间为0.0114至0.0299），2008年为0.0053（95%置信区间为0.0015至0.0091），这表明经济状况较低（贫困）的女性存在统计学上显著的不平等。2006年“在12周内接受产前检查”的集中指数也类似（CI2006 = 0.0956，95%置信区间为0.0516至0.1396）。“产后访视”和“产后访视次数>3次”的集中指数为正值（2006年除外），表明贫困人群接受产后护理的次数少于非贫困人群。2008年，贫困女性剖宫产的比例高于非贫困女性（CI2008 = -0.0629，95%置信区间为 -0.1165至 -0.0093），但2006年未观察到这种差异。
2006年和2008年，中国西部农村地区贫困和非贫困经济状况的孕妇在利用孕产妇保健服务方面存在显著不平等。为贫困孕妇提供经济支持以使其能够利用医疗服务将是有益的。如果能尽量减少自付费用，孕产妇保健服务的利用率将会提高。
