Department of Health Policy, London School of Economic and Political Science, Houghton Street, London, WC2A 2AE, UK.
Int J Equity Health. 2018 Apr 11;17(1):43. doi: 10.1186/s12939-018-0752-x.
Reducing maternal mortality is a top priority in Latin American countries. Despite the progress in maternal mortality reduction, Brazil and Colombia still lag behind countries at similar levels of development.
Using data from the Demographic Health Survey, this study quantified and compared, by means of concentration indices, the socioeconomic-related inequity in access to four key maternal health interventions in Brazil and Colombia. Decomposition analysis of the concentration index was used for two indicators - skilled attendance at birth and postnatal care in Brazil.
Coverage levels of the four key maternal health interventions were similar in the two countries. More specifically, we found that coverage of some of the interventions (e.g. ante-natal care and skilled birth assistance) was higher than 90% in both countries. Nevertheless, the concentration index analysis pointed to significant pro-rich inequities in access in all four key interventions in both countries. Interestingly, the analysis showed that Colombia fared slightly better than Brazil in terms of equity in access of the interventions studied. Finally, the decomposition analysis for the presence of a skilled attendant at birth and postnatal care in Brazil underlined the significance of regional disparities, wealth inequalities, inequalities in access to private hospitals, and inequalities in access to private health insurance.
There are persistent pro-rich inequities in access to four maternal health interventions in both Brazil and Colombia. The decomposition analysis conducted on Brazilian data suggests the existence of disparities in system capacity and quality of care between the private and the public health services, resulting in inequities of access to maternal health services.
降低孕产妇死亡率是拉丁美洲国家的首要任务。尽管在降低孕产妇死亡率方面取得了进展，但巴西和哥伦比亚仍落后于发展水平相当的国家。
本研究利用来自人口健康调查的数据，通过集中指数的方法，对巴西和哥伦比亚在获得四项关键孕产妇健康干预措施方面的社会经济相关不平等情况进行了量化和比较。使用集中指数的分解分析方法对巴西的两个指标（即熟练接生和产后护理）进行了分析。
两国四项关键孕产妇健康干预措施的覆盖水平相似。更具体地说，我们发现两国一些干预措施（如产前护理和熟练接生援助）的覆盖率都在 90%以上。然而，集中指数分析表明，在两国所有四项关键干预措施中，都存在明显的有利于富裕阶层的不平等。有趣的是，分析表明，在研究的干预措施中，哥伦比亚在获取方面的公平性方面略好于巴西。最后，对巴西有熟练接生员和产后护理的存在进行的分解分析强调了区域差异、财富不平等、私立医院获得机会不平等以及私立医疗保险获得机会不平等的重要性。
在巴西和哥伦比亚，获得四项孕产妇健康干预措施的机会仍然存在有利于富裕阶层的不平等。对巴西数据进行的分解分析表明，公私医疗服务之间存在系统能力和护理质量的差异，导致孕产妇健康服务获取方面的不平等。
