Hajizadeh Mohammad, Alam Nazmul, Nandi Arijit
School of Health Administration, Faculty of Health Professions, Dalhousie University, 5161 George Street, Suite 700, Halifax, NS, B3H 4R2, Canada.
Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
Int J Equity Health. 2014 Dec 10;13:120. doi: 10.1186/s12939-014-0120-4.
Notwithstanding the significant progress in reducing maternal mortality in recent years, social inequalities in the utilization of maternal care continue to be a challenge in Bangladesh. In this study, we aim to provide a comprehensive analysis of trends in social inequalities in utilization of antenatal care (ANC), facility based delivery (FBD), and skilled birth attendance (SBA) in Bangladesh between 1995 and 2010.
Data were extracted from the five latest rounds of Bangladesh Demographic Health Surveys (BDHS). The Theil index (T) and between-group variance (BGV) were used to calculate relative and absolute disparities in the utilization of three measures (ANC, FBD, and SBA) of maternal care across six administrative regions. The relative and slope indices of inequality (RII and SII, respectively) were also used to calculate wealth- and education-based inequality in the utilization of maternal care.
The results of the T-index suggest that relative inequality in SBA has declined by 0.2% per year. Nevertheless, the estimated BGV demonstrated that absolute inequalities in all three measures of maternal care have increased across administrative divisions. For all three measures of maternal care, the RII and SII indicated consistent socioeconomic inequalities favouring wealthier and more educated women. The adjusted RII suggested that wealth- and education-related inequalities for ANC declined by 9% and 6%, respectively, per year during the study period. The adjusted SII, however, showed that wealth- and education-related inequalities for FBD increased by 0.6% per year.
Although socially disadvantaged mothers increased their utilization of care relative to mothers of higher socioeconomic status, the absolute gap in utilization of care between socioeconomic groups has increased over time. Our findings indicate that wealthier and more educated women, as well as those living in urban areas, are the major users of ANC, FBD and SBA in Bangladesh. Thus, priority focus should be given to implementing and evaluating interventions that benefit women who are poorer, less educated and live in rural areas.
尽管近年来在降低孕产妇死亡率方面取得了重大进展，但在孟加拉国，孕产妇保健利用方面的社会不平等仍然是一项挑战。在本研究中，我们旨在全面分析1995年至2010年期间孟加拉国产前保健（ANC）、设施分娩（FBD）和熟练接生（SBA）利用方面的社会不平等趋势。
数据取自孟加拉国人口与健康调查（BDHS）的最近五轮调查。泰尔指数（T）和组间方差（BGV）用于计算六个行政区孕产妇保健三项指标（ANC、FBD和SBA）利用方面的相对和绝对差距。不平等的相对指数和斜率指数（分别为RII和SII）也用于计算孕产妇保健利用方面基于财富和教育的不平等。
T指数结果表明，SBA方面的相对不平等每年下降0.2%。然而，估计的BGV表明，所有三项孕产妇保健指标在各行政区的绝对不平等都有所增加。对于所有三项孕产妇保健指标，RII和SII表明存在有利于较富裕和受教育程度较高女性的一致社会经济不平等。调整后的RII表明，在研究期间，ANC方面与财富和教育相关的不平等分别每年下降9%和6%。然而，调整后的SII表明，FBD方面与财富和教育相关的不平等每年增加0.6%。
尽管社会经济地位较低的母亲相对于社会经济地位较高的母亲增加了保健利用，但随着时间的推移，社会经济群体之间在保健利用方面的绝对差距有所扩大。我们的研究结果表明，较富裕、受教育程度较高的女性以及居住在城市地区的女性是孟加拉国ANC、FBD和SBA的主要使用者。因此，应优先关注实施和评估有利于较贫穷、受教育程度较低且居住在农村地区女性的干预措施。
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