Makate Marshall, Makate Clifton
Department of Economics, State University of New York at Albany, Albany, NY 12222 USA.
UNEP Tongji Institute of Environment for Sustainable Development, Tongji University, Shanghai, China.
Glob Health Res Policy. 2017 Jan 5;2:1. doi: 10.1186/s41256-016-0021-8. eCollection 2017.
Inequalities in maternal health care are pervasive in the developing world, a fact that has led to questions about the extent of these disparities across socioeconomic groups. Despite a growing literature on maternal health across Sub-Saharan African countries, relatively little is known about the evolution of these inequalities over time for specific countries. This study sought to quantify and explain the observed differences in prenatal care use and professional delivery assistance in Zimbabwe.
The empirical analysis uses four rounds of the nationwide Zimbabwe Demographic and Health Survey administered in 1994, 1999, 2005/06 and 2010/11. Two binary indicators were used as measures of maternal health care utilization; (1) the receipt of four or more antenatal care visits and (2) receiving professional delivery assistance for the most recent pregnancy. We measure inequalities in maternal health care use using the Erreygers corrected concentration index. A decomposition analysis was conducted to determine the underlying drivers of the measured disparities.
The computed concentration indices for professional delivery assistance and prenatal care reveal a mostly pro-rich distribution of inequalities between 1994 and 2011. Particularly, the concentration index [95% confidence interval] for the receipt of prenatal care was 0.111 [0.056, 0.171] in 2005/06 and 0.094 [0.057, 0.138] in 2010/11. For professional delivery assistance, the concentration index stood at 0.286 [0.244, 0.329] in 2005/06 and 0.324 [0.283, 0.366] in 2010/11. The pro-rich inequality was also increasing in both rural and urban areas over time. The decomposition exercise revealed that wealth, education, religion and information access were the underlying drivers of the observed inequalities in maternal health care.
In Zimbabwe, socioeconomic disparities in maternal health care use are mostly pro-rich and have widened over time regardless of the location of residence. Overall, we established that inequalities in wealth and education are amongst the top drivers of the observed disparities in maternal health care. These findings suggest that addressing inequalities in maternal health care utilization requires coordinated public policies targeting the more poor and vulnerable segments of the population in Zimbabwe.
孕产妇保健方面的不平等在发展中世界普遍存在，这一事实引发了关于这些差距在不同社会经济群体间的程度的问题。尽管关于撒哈拉以南非洲国家孕产妇健康的文献越来越多，但对于特定国家这些不平等随时间的演变情况却知之甚少。本研究旨在量化并解释在津巴布韦观察到的产前护理利用和专业分娩协助方面的差异。
实证分析使用了1994年、1999年、2005/06年和2010/11年在津巴布韦全国范围内进行的四轮人口与健康调查。使用两个二元指标作为孕产妇保健利用的衡量标准；（1）接受四次或更多次产前检查，以及（2）最近一次怀孕时接受专业分娩协助。我们使用埃雷格斯校正集中指数来衡量孕产妇保健利用方面的不平等。进行了分解分析以确定所测差距的潜在驱动因素。
计算得出的专业分娩协助和产前护理的集中指数显示，1994年至2011年间不平等现象大多有利于富人。特别是，2005/06年接受产前护理的集中指数[95%置信区间]为0.111[0.056，0.171]，2010/11年为0.094[0.057，0.138]。对于专业分娩协助，2005/06年集中指数为0.286[0.244，0.329]，2010/11年为0.324[0.283，0.366]。随着时间推移，有利于富人的不平等在农村和城市地区也都在增加。分解分析表明，财富、教育、宗教和信息获取是观察到的孕产妇保健不平等的潜在驱动因素。
在津巴布韦，孕产妇保健利用方面的社会经济差距大多有利于富人，且无论居住地点如何，都随时间而扩大。总体而言，我们确定财富和教育方面的不平等是观察到的孕产妇保健差距的主要驱动因素之一。这些发现表明，解决孕产妇保健利用方面的不平等需要针对津巴布韦更贫困和脆弱人群制定协调一致的公共政策。
