Benova Lenka, Campbell Oona M R, Ploubidis George B
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Centre for Longitudinal Studies, Institute of Education, London, WC1H 0AL, UK.
BMC Health Serv Res. 2015 Jan 21;15:1. doi: 10.1186/s12913-014-0652-8.
BACKGROUND: The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care. METHODS: Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private). RESULTS: While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources. CONCLUSIONS: Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term.
背景:埃及就医行为中社会经济不平等的程度和根源尚不清楚。本文评估了与孕产妇保健(产前保健[ANC]和机构分娩)相关的就医行为水平及其在孕期和分娩期间的累积情况。其次,探讨社会经济地位(SEP)与孕产妇就医行为之间关联的潜在机制。第三,检验免费公共产前保健和分娩护理的目标针对性效果。 方法:使用2008年人口与健康调查的数据来获取社会经济地位的两个潜在构成要素:个人社会文化资本和家庭层面的经济资本。将这些变量纳入一个调整后的中介模型,预测孕产妇就医行为的12个维度;包括任何产前保健、私人产前保健、孕早期首次产前检查、定期产前保健(孕期4次或更多次检查)、机构分娩和私人分娩。产前保健和分娩护理费用按提供者类型(公立或私立)分别进行考察。 结果:在5年回顾期内生育的妇女中,74.2%接受了任何产前保健,72.4%在机构分娩,但只有48.8%的妇女为其最近一次活产获得了完整的孕产妇保健套餐(及时且定期的基于机构的产前保健以及机构分娩)。社会文化资本和经济资本均与接受任何产前保健和在机构分娩独立正相关。在预测私人提供者提供产前保健和分娩服务的模型中,社会文化资本的直接影响最为显著。尽管大量使用公共提供者的妇女报告接受了免费护理(产前保健:38%,分娩:24%),但这种免费的公共护理并未有效地针对经济资源最低的妇女。 结论:社会文化资本是导致埃及孕产妇就医不平等的主要机制。因此,未来的研究应考察不同类型提供者护理的客观质量和感知质量。改善免费公共护理的目标针对性有助于在短期内减少现有的基于社会经济地位的孕产妇护理覆盖不平等现象。
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