Department of Statistics, Tejgaon College, National University Bangladesh, Dhaka, Bangladesh.
Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Liverpool, New South Wales, Australia.
BMJ Open. 2023 Oct 10;13(10):e070111. doi: 10.1136/bmjopen-2022-070111.
This study investigated the inequalities in access to maternal healthcare services in Bangladesh.
This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017-2018. The survey encompassed diverse regions and households across Bangladesh. The study used the Human Opportunity Index (HOI) and Shapley's decomposition technique to measure the inequality in access to maternal healthcare opportunities.
This study included 20 127 women aged 15-49 years. Among them, 5012 women had live births in the preceding 3 years of the survey, forming the study sample.
This study has no secondary outcome variable. The primary dependent variable is 'adequate maternal healthcare', a dichotomous variable.
Household wealth status contributed the highest to inequality in accessing adequate maternal healthcare services (41.4%) such as receiving at least four antenatal care (ANC) visits (39.7%), access to proper ANC (50.7% and 44.0%) and health facility birth (43.4%). Maternal educational status contributes the second highest inequality among all factors in accessing adequate maternal healthcare (29.5%). Adequate maternal healthcare presented the lowest coverage rate and opportunity index among all (approximately 24% with HOI=17.2).
We found that attained adequate maternal healthcare had the lowest coverage and widest dissimilarity, while wealth index, education and place of residence are the major factors that contribute to inequalities in accessibility to maternal healthcare services in Bangladesh. These findings underscore a need for pro-poor interventions to narrow the economic inequalities between the poor and rich in terms of accessibility to maternal healthcare services. The results indicate the need for the Bangladeshi government and its health department to strengthen their commitment to improving female education. Investments should be made in initiatives that facilitate the proximity of maternal healthcare services to women in rural areas.
本研究旨在探讨孟加拉国产妇保健服务获取方面的不平等现象。
本研究使用了 2017-2018 年全国代表性的孟加拉国人口与健康调查的横断面数据。该调查涵盖了孟加拉国不同地区和家庭。本研究使用人类机会指数（HOI）和 Shapley 分解技术来衡量产妇保健机会获取方面的不平等。
本研究纳入了 20127 名年龄在 15-49 岁的妇女。其中，5012 名妇女在调查前 3 年内有活产，构成了研究样本。
本研究没有次要结果变量。主要因变量是“适当的产妇保健”，这是一个二分变量。
家庭财富状况对获得适当产妇保健服务的不平等贡献最大（41.4%），例如接受至少 4 次产前护理（ANC）就诊（39.7%）、获得适当的 ANC（50.7%和 44.0%）和在医疗设施分娩（43.4%）。产妇教育状况在所有因素中对获得适当产妇保健的不平等贡献排名第二（29.5%）。适当的产妇保健在所有方面的覆盖率和机会指数最低（约 24%，HOI=17.2）。
我们发现，获得充分的产妇保健的覆盖率最低，差异最大，而财富指数、教育和居住地是导致孟加拉国产妇保健服务获取不平等的主要因素。这些发现突显出需要采取扶贫干预措施，缩小贫困和富裕人群在获得产妇保健服务方面的经济不平等。结果表明，孟加拉国政府及其卫生部门需要加强对提高女性教育的承诺。应投资于促进产妇保健服务向农村地区妇女提供的举措。
