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Maternal and Child Health Journal
Published in: Maternal and Child Health Journal 4/2015

01-04-2015

Explaining Inequity in the Use of Institutional Delivery Services in Selected Countries

Authors: Mai Do, Rieza Soelaeman, David R. Hotchkiss

Published in: Maternal and Child Health Journal | Issue 4/2015

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Abstract

Wealth-related disparities in the use of reproductive health services remain a substantial problem in many low- and middle-income countries. Very few studies have attempted to explain such inequalities through decomposition of the contributions made by various individual- and household-level factors. This study aims to: (1) assess the degree of wealth-related inequality and inequity in the use of institutional delivery services in selected low- and middle-income countries, and (2) to explain wealth-related inequity through decomposition by the contributions made by various components, including health insurance coverage. Data come from Demographic and Health Surveys in three countries: Ghana, Rwanda, and the Philippines. Concentration indices are used to calculate inequality and horizontal inequity in service utilization. Multivariate methods are used to decompose inequity. Findings indicate a moderate to high degree of inequity in institutional delivery service use in all study countries. The study provides some evidence of the contribution of health insurance to increased wealth-related inequity in the use of institutional delivery services, although having health insurance was also associated with increased utilization of services. Results suggest that increased health insurance coverage does not automatically translate to lower wealth-related inequity in service utilization. Inequities in service utilization exist if there are still inequities in the health insurance status. The study advocates for expanding health insurance coverage, particularly among the poor to reduce inequity in insurance coverage and increase service utilization.
Footnotes
1
We limit the sample to childbirths within 2 years before the survey for two reasons: (1) to allow time for health insurance to exert effects, if any, from its introduction to the time of the survey, and (2) because most independent variables were measured at the time of the survey, doing so will make childbirth-related information (which refers to the preceding two years) relevant time-wise.
 
2
In Ghana, a national delivery exemption policy was introduced in 2004, which removed the costs of delivery care at public and private sector; women only had to bear the costs of reaching facilities [50]. However, the policy was believed to be underfunded, and coupled with a health worker strike in 2007, it was soon abolished [51]. While lowering the costs of institutional delivery care, the policy seemed to benefit the rich more than the poor [52]. At the time of the DHS 2008, this policy was not being fully implemented; it may have some positive effects on women who gave birth earlier in the study period but the effects are likely minimal.
 
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Metadata
Title
Explaining Inequity in the Use of Institutional Delivery Services in Selected Countries
Authors
Mai Do
Rieza Soelaeman
David R. Hotchkiss
Publication date
01-04-2015
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 4/2015
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-014-1561-5

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