JW Lee Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 13087, Republic of Korea.
Department of Global Health, Hanoi Medical University, Hanoi, Vietnam.
BMC Public Health. 2018 Jul 13;18(1):875. doi: 10.1186/s12889-018-5811-0.
Socioeconomic inequalities in access to maternal health care have received more attention as it challenges the sustainability of the ongoing achievement in reducing maternal mortality. By promoting access to maternal health care as one of the core targets of the Health Sector Reform, Lao People's Democratic Republic has reduced maternal mortality dramatically over the last decade. In spite of this improvement, little has been known about the secular trends in disparities of service utilization across different socioeconomic subgroups.
Two waves of the Multiple Indicator Cluster Survey in the years 2000 and 2012 were pooled for the analysis. We used logistic regression to estimate the likelihood of using antenatal care (ANC) and delivery services with skilled birth attendants (SBA) across different socioeconomic subgroups. Difference-in-difference method was applied to examine the inequality trends across the years by analyzing the interaction terms of the survey years and socioeconomic factors (education, wealth, ethnicity, and residential areas).
Urban-rural disparity was improved over time while there were no educational disparity changes. Rural residential areas showed significant changes than urban areas over time [OR = 2.40; 95% CI: 1.52-3.77 for ANC and OR = 2.16; 95% CI: 1.36-3.42 for SBA]. However, there were aggravations in the disparities between major and minor ethnic group as well as worsening disparities between the rich and poor: i.e. Ethnic minority showed significant aggravation over time [OR = 0.62; 95% CI: 0.44-0.89 for ANC and OR = 0.65; 95% CI: 0.44-0.97 for SBA].
Efforts to increase maternal health service utilization in poor and minority ethnic groups should be emphasized to reduce social inequalities, thus encompassing multiple-sector interventions rather than focusing only on health sector related interventions.
社会经济不平等在获得孕产妇保健方面受到了更多关注，因为这对降低孕产妇死亡率方面持续取得的成果构成了挑战。老挝人民民主共和国通过将获得孕产妇保健作为卫生部门改革的核心目标之一，在过去十年中大大降低了孕产妇死亡率。尽管取得了这一改善，但对于不同社会经济亚组之间服务利用差异的长期趋势却知之甚少。
将 2000 年和 2012 年两轮多指标类集调查的数据合并进行分析。我们使用逻辑回归估计不同社会经济亚组使用产前护理（ANC）和熟练接生服务的可能性。通过分析调查年份和社会经济因素（教育、财富、种族和居住地区）的交互项，采用差值法来检测多年来的不平等趋势。
城乡差距随着时间的推移而缩小，而教育差距则没有变化。农村地区的变化比城市地区更为显著[ANC 的比值比（OR）=2.40；95%可信区间（CI）：1.52-3.77；SBA 的 OR=2.16；95%CI：1.36-3.42]。然而，在主要和次要少数民族之间以及贫富之间的差距却在加剧：即少数民族在过去的时间里显著恶化[ANC 的 OR=0.62；95%CI：0.44-0.89；SBA 的 OR=0.65；95%CI：0.44-0.97]。
应该加强在贫困和少数民族群体中增加孕产妇保健服务利用的努力，以减少社会不平等，从而涵盖多部门干预措施，而不仅仅是关注卫生部门相关的干预措施。
