Jain Anrudh K, Sathar Zeba A, ul Haque Minhaj
Distinguished Scholar, Population Council, One Dag Hammarskjold Plaza, New York, NY 10017.
Stud Fam Plann. 2015 Mar;46(1):21-39. doi: 10.1111/j.1728-4465.2015.00013.x.
While institutional deliveries in Pakistan have risen substantially over the last few years, the change has mainly occurred among the wealthy and those with access to services in urban areas. We assess the influence of economic and geographic access to health facilities on institutional deliveries by linking household survey data and georeferenced distance to facilities equipped to provide services for obstetric care in nine districts in Pakistan. Multilevel mixed-effect logistic regression analyses show that the net effect of an increase in distance to a facility by 1 kilometer is to decrease the odds of an institutional delivery by 3 percent. In contrast, household wealth and availability of at least basic emergency care within 10 kilometers substantially increase the odds of an institutional delivery. These effects are more pronounced in rural areas than in urban areas. Disadvantages faced by poor rural women can be minimized by upgrading existing facilities at district and subdistrict levels to provide comprehensive emergency care and by facilitating transportation of poor rural women directly to these facilities when they experience life-threatening complications of childbirth.
虽然在过去几年里，巴基斯坦的机构分娩数量大幅增加，但这种变化主要发生在富人和那些能够在城市地区获得服务的人群中。我们通过将家庭调查数据与到巴基斯坦九个地区配备产科护理服务设施的地理参考距离相联系，评估经济和地理上获得卫生设施的机会对机构分娩的影响。多层次混合效应逻辑回归分析表明，距离设施每增加1公里，机构分娩的几率就会降低3%。相比之下，家庭财富以及10公里范围内至少有基本急诊护理，会大幅增加机构分娩的几率。这些影响在农村地区比在城市地区更为明显。通过升级地区和分区层面的现有设施以提供全面的急诊护理，并在贫困农村妇女出现危及生命的分娩并发症时，为她们提供便利直接将其送往这些设施，可以将贫困农村妇女面临的不利因素降至最低。
