Department of Community Medicine, School of Medicine and Dentistry, The University of Dodoma, Dodoma, Tanzania.
PLoS One. 2021 Feb 16;16(2):e0246995. doi: 10.1371/journal.pone.0246995. eCollection 2021.
Despite skilled attendance during childbirth has been linked with the reduction of maternal deaths, equality in accessing this safe childbirth care is highly needed to achieving universal maternal health coverage. However, little information is available regarding the extent of inequalities in accessing safe childbirth care in Tanzania. This study was performed to assess the current extent, trend, and potential contributors of poor-rich inequalities in accessing safe childbirth care among women in Tanzania.
This study used data from 2004, 2010, and 2016 Tanzania Demographic Health Surveys. The two maternal health services 1) institutional delivery and 2) skilled birth attendance was used to measures access to safe childbirth care. The inequalities were assessed by using concentration curves and concentration indices. The decomposition analysis was computed to identify the potential contributors to the inequalities in accessing safe childbirth care.
A total of 8725, 8176, and 10052 women between 15 and 49 years old from 2004, 2010, and 2016 surveys respectively were included in the study. There is an average gap (>50%) between the poorest and richest in accessing safe childbirth care during the study period. The concentration curves were below the line of inequality which means women from rich households have higher access to the institutional delivery and skilled birth attendance inequalities in accessing institutional delivery and skilled birth attendance. These were also, confirmed with their respective positive concentration indices. The decomposition analysis was able to unveil that household's wealth status, place of residence, and maternal education as the major contributors to the persistent inequalities in accessing safe childbirth care.
The calls for an integrated policy approach which includes fiscal policies, social protection, labor market, and employment policies need to improve education and wealth status for women from poor households. This might be the first step toward achieving universal maternal health coverage.
尽管熟练的分娩护理与降低产妇死亡人数有关，但要实现普遍的孕产妇健康覆盖，仍非常需要平等获得这种安全的分娩护理。然而，关于坦桑尼亚在获得安全分娩护理方面的不平等程度，信息很少。本研究旨在评估坦桑尼亚妇女获得安全分娩护理的当前程度、趋势和潜在不平等因素。
本研究使用了 2004 年、2010 年和 2016 年坦桑尼亚人口健康调查的数据。使用两项产妇保健服务 1）机构分娩和 2）熟练的分娩护理来衡量获得安全分娩护理的情况。使用集中曲线和集中指数评估不平等。进行分解分析以确定导致获得安全分娩护理不平等的潜在因素。
共有 8725、8176 和 10052 名分别来自 2004 年、2010 年和 2016 年调查的 15 至 49 岁的妇女被纳入研究。在研究期间，最贫困和最富裕的妇女在获得安全分娩护理方面存在平均差距（>50%）。集中曲线位于不平等线以下，这意味着富裕家庭的妇女在获得机构分娩和熟练的分娩护理方面的机会更高，而这也得到了各自正集中指数的证实。分解分析能够揭示出家庭的财富状况、居住地点和产妇教育是导致获得安全分娩护理持续不平等的主要因素。
需要采取综合政策方法，包括财政政策、社会保护、劳动力市场和就业政策，以提高贫困家庭妇女的教育和财富水平。这可能是实现普遍孕产妇健康覆盖的第一步。
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