Skip to main content
Top
Published in: International Journal for Equity in Health 1/2011

Open Access 01-12-2011 | Research

Wealth inequality and utilization of reproductive health services in the Republic of Vanuatu: insights from the multiple indicator cluster survey, 2007

Authors: Mosiur Rahman, Syed E Haque, Md G Mostofa, Len Tarivonda, Muhammad Shuaib

Published in: International Journal for Equity in Health | Issue 1/2011

Login to get access

Abstract

Background

Although the Republic of Vanuatu has improved maternal indicators, more needs to be done to improve equity among the poorest in the use of reproductive health services to expedite the progress towards the Millennium Development Goal 5(MDG 5) target. While large developing country studies provide evidence of a rich-poor gap in reproductive health services utilization, not much is written in terms of Pacific Islands. Thus, this study aims to examine the degree of inequality in utilization of reproductive health services in a nationally representative sample of Vanuatu households.

Methods

This paper used data from the 2007 Vanuatu Multiple Indicator Cluster Survey (MICS). The analyses were based on responses from 615 ever married women, living with at least one child below two years of age. Outcomes included antenatal care (ANC) and use of birth attendants at delivery, place of delivery, and counseling and testing for HIV/AIDS. Descriptive statistics and multivariate logistic regression methods were employed in the analysis.

Results

Findings revealed that the economic well-being status of the household to which women belong, played a crucial role in explaining the variation in service utilization. Inequality in utilization was found to be more pronounced between the poorest and richest groups within the wealth quintiles. In adjusted models, mothers in the richest bands of wealth were 5.50 (95% confidence interval [CI]: 1.34-22.47), 2.12 (95% CI: 1.02-3.42), 4.0 (95% CI 1.58-10.10), and 2.0 (95% CI 1.02-5.88) times more likely to have assisted delivery from medically trained personnel, have institutional deliveries, and have counseling and testing for HIV/AIDS.

Conclusions

Association between household wealth inequality and utilization of ANC and delivery assistance from medically trained personnel, institutional delivery, and counseling and testing for HIV/AIDS suggest that higher utilization of reproductive health care services in Vanuatu poor-rich inequalities need to be addressed. Reducing poverty and making services more available and accessible to the poor may be essential for improving overall reproductive health care utilization rate in Vanuatu.
Appendix
Available only for authorised users
Literature
1.
go back to reference World health Organization (WHO): Goal 5-Improve maternal health: Pacific Islands Regional MDG Report. Geneva. 2004 World health Organization (WHO): Goal 5-Improve maternal health: Pacific Islands Regional MDG Report. Geneva. 2004
4.
go back to reference AUSAID: Vanuatu country overview. 2010, Australian Government AUSAID: Vanuatu country overview. 2010, Australian Government
5.
go back to reference Munsur AM, Atia A, Kawahara K: Relationship between educational attainment and maternal health care utilization in Bangladesh: evidence from the 2005 Bangladesh household income and expenditure survey. Research Journal of Medical sciences. 2010, 4 (1): 33-37.CrossRef Munsur AM, Atia A, Kawahara K: Relationship between educational attainment and maternal health care utilization in Bangladesh: evidence from the 2005 Bangladesh household income and expenditure survey. Research Journal of Medical sciences. 2010, 4 (1): 33-37.CrossRef
6.
go back to reference Countdown to 2015 decade report 2000-2010: Taking stock of maternal, newborn and child survival. 2010, Geneva: World Health Organization and UNICEF Countdown to 2015 decade report 2000-2010: Taking stock of maternal, newborn and child survival. 2010, Geneva: World Health Organization and UNICEF
7.
go back to reference Ministry of Health (MOH): Millennium development Goals 2010 Report for Vanuatu. Prime Minister's Office. 2010, The Republic of Vanuatu Ministry of Health (MOH): Millennium development Goals 2010 Report for Vanuatu. Prime Minister's Office. 2010, The Republic of Vanuatu
8.
go back to reference Magadi MA, Madise , Rodrigues : Frequency and timing of antenatal care in Kenya: Explaining variations between women of different communities. Social Science and Medicine. 2000, 5 (4): 551-561.CrossRef Magadi MA, Madise , Rodrigues : Frequency and timing of antenatal care in Kenya: Explaining variations between women of different communities. Social Science and Medicine. 2000, 5 (4): 551-561.CrossRef
9.
go back to reference Bhatia J, Cleland : Determinants of maternal care in a region of South India. Health Transition Review. 1995, 6: 45-60. Bhatia J, Cleland : Determinants of maternal care in a region of South India. Health Transition Review. 1995, 6: 45-60.
10.
go back to reference Population Refrenece Bureau (PRB): Improving the health of the World's poorest people. Washington, DC. 2004 Population Refrenece Bureau (PRB): Improving the health of the World's poorest people. Washington, DC. 2004
12.
go back to reference Whitehead Margaret, et al: "Developing the policy response to inequities in health: a global perspective," in challenging inequities in health: from ethics to action. Edited by: Timothy Evans et al. 2001, New York: Oxford University Press, 314-15. Whitehead Margaret, et al: "Developing the policy response to inequities in health: a global perspective," in challenging inequities in health: from ethics to action. Edited by: Timothy Evans et al. 2001, New York: Oxford University Press, 314-15.
14.
go back to reference Mahmud S: How equitable is access to and use of reproductive health care and family planning services in Bangladesh? A review of the evidence. Paper presented at the IUSSP conference. 2009, Bangladesh Institute of Development Studies Mahmud S: How equitable is access to and use of reproductive health care and family planning services in Bangladesh? A review of the evidence. Paper presented at the IUSSP conference. 2009, Bangladesh Institute of Development Studies
15.
go back to reference Population Reference Bureau (PRB): Globally and locally, a rich-poor gap persists. Washington, DC. 2007 Population Reference Bureau (PRB): Globally and locally, a rich-poor gap persists. Washington, DC. 2007
16.
go back to reference Gwatkin D: Initial country-level information about socio-economic differences in health, nutrition, and population. 2003 Gwatkin D: Initial country-level information about socio-economic differences in health, nutrition, and population. 2003
17.
go back to reference Ashford LS, Davidson RG, Yazbeck AS: Designing health and population programs to reach the poor. 2005, Agency for International Development under the BRIDGE project. Population Reference Bureau Ashford LS, Davidson RG, Yazbeck AS: Designing health and population programs to reach the poor. 2005, Agency for International Development under the BRIDGE project. Population Reference Bureau
18.
go back to reference Silvia P, Rekha M, Aslihan K, Charles A: Targeting poverty and gender inequality to improve maternal health. 2010, International Center for Research for Women Silvia P, Rekha M, Aslihan K, Charles A: Targeting poverty and gender inequality to improve maternal health. 2010, International Center for Research for Women
19.
go back to reference Bandara A: Emerging health issues in Asis and the Pacific: implications for public health policy. Asia-Pacific Development Journal. 2005, 12 (2): Bandara A: Emerging health issues in Asis and the Pacific: implications for public health policy. Asia-Pacific Development Journal. 2005, 12 (2):
20.
go back to reference Zere E, Tumusiime P, Walker O, Joses K, Mwikisa C, Mbeeli T: inequalities in utilization of maternal health interventions in Namibia: implications for progress towards MDG 5 targets. International Journal for Equity in Health. 2010, 9: 16-10.1186/1475-9276-9-16.PubMedCentralCrossRefPubMed Zere E, Tumusiime P, Walker O, Joses K, Mwikisa C, Mbeeli T: inequalities in utilization of maternal health interventions in Namibia: implications for progress towards MDG 5 targets. International Journal for Equity in Health. 2010, 9: 16-10.1186/1475-9276-9-16.PubMedCentralCrossRefPubMed
21.
go back to reference Houweling TAJ, Ronsmans C, Campbell OMR, Kunst AE: Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bulletin of the World Health Organization. 2007, 85 (10): Houweling TAJ, Ronsmans C, Campbell OMR, Kunst AE: Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bulletin of the World Health Organization. 2007, 85 (10):
22.
go back to reference Zere E, Moeti M, Kirigia J, Mwase T, Kataika E: Equity in health and healthcare in Malawi: analysis of trends. BMC Public Health. 2007, 7: 78-10.1186/1471-2458-7-78.PubMedCentralCrossRefPubMed Zere E, Moeti M, Kirigia J, Mwase T, Kataika E: Equity in health and healthcare in Malawi: analysis of trends. BMC Public Health. 2007, 7: 78-10.1186/1471-2458-7-78.PubMedCentralCrossRefPubMed
23.
go back to reference Pathak PK, Singh A, Subramanian SV: Economic inequalities in maternal health care: prenatal care and skilled birth attendance in India, 1992-2006. PLoS ONE. 2008, 5 (10): e13593-CrossRef Pathak PK, Singh A, Subramanian SV: Economic inequalities in maternal health care: prenatal care and skilled birth attendance in India, 1992-2006. PLoS ONE. 2008, 5 (10): e13593-CrossRef
24.
go back to reference Praveen KP: Rich-poor gap in utilization of delivery care services in India, 1992-2005. 2006, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai-400088, India Praveen KP: Rich-poor gap in utilization of delivery care services in India, 1992-2005. 2006, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai-400088, India
25.
go back to reference Collin S, Anwar I, Rosmans C: A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991-2004). International Journal of Equity in Health. 2009, 6 (9): Collin S, Anwar I, Rosmans C: A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991-2004). International Journal of Equity in Health. 2009, 6 (9):
26.
go back to reference Ministry of Health, Government of Vanuatu: Vanuatu Multiple Indicator Cluster Survey 2007, Final Report. 2008, Port Vila, Vanuatu Ministry of Health, Government of Vanuatu: Vanuatu Multiple Indicator Cluster Survey 2007, Final Report. 2008, Port Vila, Vanuatu
27.
go back to reference Filmer D, Pritchett LH: Estimating wealth effects without expenditure data-or tears: an application to educational enrollments in states of India. Demography. 2001, 38: 115-132.PubMed Filmer D, Pritchett LH: Estimating wealth effects without expenditure data-or tears: an application to educational enrollments in states of India. Demography. 2001, 38: 115-132.PubMed
28.
go back to reference Bloom SS, Lippeveld T, Wypij D: Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India. Health Policy and Planning. 1999, 14 (1): 38-48. 10.1093/heapol/14.1.38.CrossRefPubMed Bloom SS, Lippeveld T, Wypij D: Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India. Health Policy and Planning. 1999, 14 (1): 38-48. 10.1093/heapol/14.1.38.CrossRefPubMed
29.
go back to reference Chakraborty N, Islam MA, Chowdhury RI, Bari W: Utilization of postnatal care in Bangladesh: evidence from a longitudinal study. Health and Social Care in Community. 2002, 10 (6): 492-502. 10.1046/j.1365-2524.2002.00389.x.CrossRef Chakraborty N, Islam MA, Chowdhury RI, Bari W: Utilization of postnatal care in Bangladesh: evidence from a longitudinal study. Health and Social Care in Community. 2002, 10 (6): 492-502. 10.1046/j.1365-2524.2002.00389.x.CrossRef
30.
go back to reference Elo TI: Utilization of maternal health-care services in Peru: the role of women's education. Health Transition Review. 1992, 2: 49-69.PubMed Elo TI: Utilization of maternal health-care services in Peru: the role of women's education. Health Transition Review. 1992, 2: 49-69.PubMed
31.
go back to reference Rahman M: Modes of delivery assistance in Bangladesh. Tanzanian Journal of Health Research. 2008, 10 (4): 246-256. Rahman M: Modes of delivery assistance in Bangladesh. Tanzanian Journal of Health Research. 2008, 10 (4): 246-256.
32.
go back to reference Wagstaff A, Paci P, Van Doorslaer E: On the measurement of inequalities in health. Social Science and Medicine. 1991, 33 (5): 545-557. 10.1016/0277-9536(91)90212-U.CrossRefPubMed Wagstaff A, Paci P, Van Doorslaer E: On the measurement of inequalities in health. Social Science and Medicine. 1991, 33 (5): 545-557. 10.1016/0277-9536(91)90212-U.CrossRefPubMed
33.
go back to reference Chan YH: Biostatistics: logistic regression analysis. Singapore Med J. 2004, 45: 149-PubMed Chan YH: Biostatistics: logistic regression analysis. Singapore Med J. 2004, 45: 149-PubMed
34.
go back to reference Houweling TAJ, Ronsmans C, Campbell OMR, Kunst AE: Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bulletin of the World Health Organization. 2007, 85 (10): Houweling TAJ, Ronsmans C, Campbell OMR, Kunst AE: Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bulletin of the World Health Organization. 2007, 85 (10):
35.
go back to reference Zere E, Moeti M, Kirigia J, Mwase T, Kataika E: Equity in health and healthcare in Malawi: analysis of trends. BMC Public Health. 2007, 7: 78-10.1186/1471-2458-7-78.PubMedCentralCrossRefPubMed Zere E, Moeti M, Kirigia J, Mwase T, Kataika E: Equity in health and healthcare in Malawi: analysis of trends. BMC Public Health. 2007, 7: 78-10.1186/1471-2458-7-78.PubMedCentralCrossRefPubMed
36.
go back to reference Ministry of Health, the Republic of Vanuatu (MOH): National Health Accounts 2005, including Aus AID technical assistance would raise the donor share to 24 per cent of total health spending, and 30 per cent of public spending. 2007, MOH, Vanuatu Ministry of Health, the Republic of Vanuatu (MOH): National Health Accounts 2005, including Aus AID technical assistance would raise the donor share to 24 per cent of total health spending, and 30 per cent of public spending. 2007, MOH, Vanuatu
37.
go back to reference Overbosch GB, Nsowah-Nuamah NNN, Van den Boom GJM, Mamnyag L: Determinant's of antenatal care use in Ghana. Journal of African Economies. 2004, 13: 277-301.CrossRef Overbosch GB, Nsowah-Nuamah NNN, Van den Boom GJM, Mamnyag L: Determinant's of antenatal care use in Ghana. Journal of African Economies. 2004, 13: 277-301.CrossRef
38.
go back to reference Chakraborty N, Islam MA, Chowdhury RI, Bari W, Akhter HH: Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International. 2003, 18: 327-337. 10.1093/heapro/dag414.CrossRefPubMed Chakraborty N, Islam MA, Chowdhury RI, Bari W, Akhter HH: Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International. 2003, 18: 327-337. 10.1093/heapro/dag414.CrossRefPubMed
39.
go back to reference Cochrane SH, O'Hara DJ, Leslie J: The effects of education on health: a background study for world development report. 1980, World Bank, Washington, D.C. Cochrane SH, O'Hara DJ, Leslie J: The effects of education on health: a background study for world development report. 1980, World Bank, Washington, D.C.
40.
go back to reference McDonagh M: Is antenatal care effective in reducing maternal morbidity and mortality?. Health Policy and Planning. 1996, 11 (1): 1-15. 10.1093/heapol/11.1.1.CrossRefPubMed McDonagh M: Is antenatal care effective in reducing maternal morbidity and mortality?. Health Policy and Planning. 1996, 11 (1): 1-15. 10.1093/heapol/11.1.1.CrossRefPubMed
41.
go back to reference Garenne M, Mbaye K, Bah MD, Correa P: Risk factors for maternal mortality: a case control study in Dakar hospitals (Senegal). African Journal of Reproductive Health. 1997, 1: 14-24. 10.2307/3583271.CrossRefPubMed Garenne M, Mbaye K, Bah MD, Correa P: Risk factors for maternal mortality: a case control study in Dakar hospitals (Senegal). African Journal of Reproductive Health. 1997, 1: 14-24. 10.2307/3583271.CrossRefPubMed
42.
go back to reference Hartfield VJ: Maternal mortality in Nigeria compared with earlier international experience. International Journal of Gynecology and Obstetrics. 1980, 18: 70-75.PubMed Hartfield VJ: Maternal mortality in Nigeria compared with earlier international experience. International Journal of Gynecology and Obstetrics. 1980, 18: 70-75.PubMed
Metadata
Title
Wealth inequality and utilization of reproductive health services in the Republic of Vanuatu: insights from the multiple indicator cluster survey, 2007
Authors
Mosiur Rahman
Syed E Haque
Md G Mostofa
Len Tarivonda
Muhammad Shuaib
Publication date
01-12-2011
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2011
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/1475-9276-10-58

Other articles of this Issue 1/2011

International Journal for Equity in Health 1/2011 Go to the issue