Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia.
Department of Statistics, Jagannath University, Dhaka, 1100, Bangladesh.
BMC Pregnancy Childbirth. 2023 Jun 22;23(1):461. doi: 10.1186/s12884-023-05778-0.
Inequality in postnatal care (PNC) has remained a challenge in many low- and middle-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilizing PNC services for Bangladesh and Pakistan.
The study used the latest Demographic and Health Survey (DHS, 2017-2018) datasets of Bangladesh and Pakistan for women aged 15-49 years who had given at least one live birth in the three years preceding the survey. As outcome variables, three PNC service indicators were considered: PNC check of women, PNC check of newborns, and adequate PNC content of newborns. Concentration curves and equiplots were constructed to visually demonstrate inequality in PNC services. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI), and slope index of inequality (SII) were calculated to measure inequalities in the utilization of PNC services. For two categories equity strata, rate ratio (RR) and rate difference (RD) were calculated.
In Bangladesh, the level of inequality was high and almost the same for the PNC check of women and newborns based on women's education (PNC women- RCI: 0.404, ACI: 0.403, SII: 0.624; and PNC newborn- RCI: 0.402, ACI: 0.402, SII: 0.622), wealth (PNC women- RCI: 0.448, ACI: 0.448, SII: 0.643; and PNC newborn- 0.441, ACI: 0.441, SII: 0.633), and number of ANC visits (PNC women- RCI: 0.329, ACI: 0.329, SII: 0.595; and PNC newborn- RCI: 0.329, ACI: 0.329, SII: 0.594). In Pakistan, the level of inequality was higher for the PNC check of women among all PNC services based on women's education (ACI: 0.388 and SII: 0.676) and wealth (ACI: 0.397 and SII: 0.598). For Bangladesh and Pakistan, RR values (2.114 and 3.873, respectively) indicated greater media exposure-related inequality in adequate PNC content of newborns. Inequality in facility delivery was highest for PNC checks of women and newborns in Bangladesh (PNC women- RD: 0.905, PNC newborn- RD: 0.900) and Pakistan (PNC women- RD: 0.726, PNC newborn-RD: 0.743).
Inequality was higher in Bangladesh than in Pakistan for PNC checks of women and newborns based on wealth, media exposure, and mode of delivery. For adequate PNC content of newborns, inequality was greater in Pakistan than in Bangladesh. Country-specific customized policies would better minimize the gap between the privileged and underprivileged groups and reduce inequality.
在孟加拉国和巴基斯坦等许多中低收入国家，产后护理（PNC）方面的不平等仍然是一个挑战。本研究考察了孟加拉国和巴基斯坦在利用 PNC 服务方面的国内和国家间不平等。
本研究使用了孟加拉国和巴基斯坦最新的人口与健康调查（DHS，2017-2018 年）数据集，这些数据来自于在调查前三年内至少生育过一次的 15-49 岁的女性。作为产出变量，考虑了三种 PNC 服务指标：妇女的 PNC 检查、新生儿的 PNC 检查和新生儿的适当 PNC 内容。构建了集中曲线和等距图，以直观地展示 PNC 服务的不平等。对于具有两个以上类别的有序公平阶层，计算了相对集中指数（RCI）、绝对集中指数（ACI）和不平等斜率指数（SII），以衡量 PNC 服务利用方面的不平等。对于两个类别的公平阶层，计算了比率比（RR）和比率差（RD）。
在孟加拉国，基于妇女的教育（PNC 妇女-RCI：0.404，ACI：0.403，SII：0.624；和 PNC 新生儿-RCI：0.402，ACI：0.402，SII：0.622）、财富（PNC 妇女-RCI：0.448，ACI：0.448，SII：0.643；和 PNC 新生儿-RCI：0.441，ACI：0.441，SII：0.633）和接受 ANC 就诊次数（PNC 妇女-RCI：0.329，ACI：0.329，SII：0.595；和 PNC 新生儿-RCI：0.329，ACI：0.329，SII：0.594），妇女的 PNC 检查和新生儿的 PNC 检查的不平等程度很高且几乎相同。在巴基斯坦，基于妇女的教育（ACI：0.388 和 SII：0.676）和财富（ACI：0.397 和 SII：0.598），妇女的 PNC 检查的不平等程度高于所有 PNC 服务。对于孟加拉国和巴基斯坦，RR 值（分别为 2.114 和 3.873）表明，媒体接触相关的充足 PNC 新生儿内容的不平等程度更高。在孟加拉国（PNC 妇女-RD：0.905，PNC 新生儿-RD：0.900）和巴基斯坦（PNC 妇女-RD：0.726，PNC 新生儿-RD：0.743），设施分娩的 PNC 检查的不平等程度最高。
与巴基斯坦相比，孟加拉国在基于财富、媒体接触和分娩方式的妇女和新生儿的 PNC 检查方面的不平等程度更高。在为新生儿提供适当的 PNC 内容方面，巴基斯坦的不平等程度高于孟加拉国。国家特定的定制政策将更好地缩小特权和弱势群体之间的差距，并减少不平等。
