Mehata Suresh, Paudel Yuba Raj, Dariang Maureen, Aryal Krishna Kumar, Lal Bibek Kumar, Khanal Mukti Nath, Thomas Deborah
Nepal Public Health Foundation, Kathmandu 44600, Nepal.
Nepal Health Sector Support Program, Ministry of Health, Kathmandu 44600, Nepal.
Biomed Res Int. 2017;2017:5079234. doi: 10.1155/2017/5079234. Epub 2017 Jul 20.
Nepal has made significant progress against the Millennium Development Goals for maternal and child health over the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural lines.
Trends and inequalities in the use of maternal health services in Nepal between 1994 and 2011 were examined using four Nepal Demographic and Health Surveys (NDHS), nationally representative cross-sectional surveys conducted by interviewing women who gave birth 3-5 years prior to the survey. Sociodemographic disparities in maternal health service utilization were measured. Rate difference, rate ratios, and concentration index were calculated to measure income inequalities.
The percentage of mothers that received four antenatal care (ANC) consultations increased from 9% to 54%, the institutional delivery rate increased from 6% to 47%, and the cesarean section (C-section) rate increased from 1% in 1994 to 6% in 2011. The ratio of the richest and the poorest quintile mothers for use of four ANC, institutional delivery, and C-section delivery were 5.08 (95% CI: 3.82-6.76), 9.00 (95% CI: 6.55-12.37), and 9.37 (95% CI: 4.22-20.83), respectively. However, inequality is reducing over time; for the use of four ANC services, the concentration index fell from 0.60 (95% CI: 0.56-0.64) in 1994-1996 to 0.31 (95% CI: 0.29-0.33) in 2009-2011. For institutional delivery, the concentration index fell from 0.65 (95% CI: 0.62-0.70) to 0.40 (95% CI: 0.38-0.40) between 1994-1996 and 2009-2011. For C-section deliveries, an increase in concentration index was observed, 0.64 (95% CI: 0.51-0.77); 0.76 (95% CI: 0.64-0.88); 0.77 (95% CI: 0.71-0.84); and 0.66 (95% CI: 0.60-0.72) in the periods 1994-1996, 1999-2001, 2004-2006, and 2009-2011, respectively. All sociodemographic variables were significant predictors of use of maternal health services, out of which maternal education was the most powerful.
To increase equitable use of maternal health services in Nepal there is a need to strengthen the health system to increase access to and utilization of services among poorer women, those with less education, and those living in remote areas. Beyond the health sector stronger efforts are needed to tackle the root causes of health inequality, reduce poverty, increase female education, eradicate caste/ethnicity based social discrimination, and invest in the development of remote areas.
在过去二十年里，尼泊尔在实现孕产妇和儿童健康的千年发展目标方面取得了重大进展。然而，孕产妇保健服务利用方面的差距在地理、经济和社会文化层面依然存在。
利用四次尼泊尔人口与健康调查（NDHS）对1994年至2011年期间尼泊尔孕产妇保健服务的使用趋势和不平等情况进行了研究。NDHS是具有全国代表性的横断面调查，通过对在调查前3至5年分娩的妇女进行访谈开展。对孕产妇保健服务利用方面的社会人口统计学差异进行了测量。计算了率差、率比和集中指数以衡量收入不平等情况。
接受四次产前检查（ANC）的母亲比例从9%增至54%，机构分娩率从6%增至47%，剖宫产（C-section）率从1994年的1%增至2011年的6%。最富有和最贫穷五分之一母亲在接受四次产前检查、机构分娩和剖宫产方面的比例分别为5.08（95%可信区间：3.82 - 6.76）、9.00（95%可信区间：6.55 - 12.37）和9.37（95%可信区间：4.22 - 20.83）。然而，不平等状况随着时间推移在减少；就接受四次产前检查服务而言，集中指数从1994 - 1996年的0.60（95%可信区间：0.56 - 0.64）降至2009 - 2011年的0.31（95%可信区间：0.29 - 0.33）。就机构分娩而言，集中指数在1994 - 1996年至2009 - 2011年期间从0.65（95%可信区间：0.62 - 0.70）降至0.40（95%可信区间：0.38 - 0.40）。就剖宫产而言，观察到集中指数有所上升，在1994 - 1996年、1999 - 2001年、2004 - 2006年和2009 - 2011年期间分别为0.64（95%可信区间：0.51 - 0.77）、0.76（95%可信区间：0.64 - 0.88）、0.77（95%可信区间：0.71 - 0.84）和0.66（95%可信区间：0.60 - 0.72）。所有社会人口统计学变量都是孕产妇保健服务利用情况的重要预测因素，其中孕产妇教育是最有力的因素。
为了在尼泊尔更公平地利用孕产妇保健服务，有必要加强卫生系统，以增加贫困妇女、受教育较少的妇女以及生活在偏远地区的妇女获得和利用服务的机会。除卫生部门外，还需要做出更大努力来解决健康不平等的根本原因，减少贫困，提高女性教育水平，消除基于种姓/族裔的社会歧视，并投资于偏远地区的发展。
