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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2016

Open Access 01-12-2016 | Research

Trends in equity in use of maternal health services in urban and rural Bangladesh

Authors: Nahid Kamal, Sian Curtis, Mohammad S. Hasan, Kanta Jamil

Published in: International Journal for Equity in Health | Issue 1/2016

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Abstract

Background

Maternal healthcare utilization is a major determinant of maternal mortality. Bangladesh is experiencing a rapid pace of urbanization with all future growth in population expected to be in urban areas. Health care infrastructure is different in urban and rural areas thus warranting an examination of equity in use rates of maternal healthcare. This paper addresses whether the urban–rural and rich-poor gaps in use of selected maternal healthcare indicators have narrowed or widened over the last decade. The paper also explores changes in the service provider environment in urban and rural domains.

Methods

The 2001 and 2010 Bangladesh Maternal Mortality and Health Care Survey data were used to examine trends in use of antenatal care from medically trained providers and in deliveries taking place at health facilities. Separate wealth quintiles were constructed for urban and rural areas. The concentration index was calculated for urban and rural areas to measure equity in distribution of antenatal care (ANC) and facility deliveries across wealth quintiles in urban and rural domains.

Results

The gap in use of ANC provided by medically trained personnel narrowed in urban and rural areas between 2001 and 2010 while that in facility deliveries widened. The difference in use of ANC by the rich and the poor was not as pronounced as that in utilization of facilities for deliveries. Over the last decade, equity in utilization of health facilities for deliveries has improved at a faster rate in urban areas. Private sector has surpassed the public sector and appears to be the dominant provider of maternal healthcare in both domains with the share of NGOs increasing in urban areas.

Conclusions

The faster pace of improvement in equity in maternal healthcare utilization in urban areas is reflective of the changing service environment in urban and rural areas, among other factors.
Footnotes
1
Maternal mortality ratio (MMR) measures the mortality risk associated with each live birth.
 
2
NGO Health Service Delivery Project (commonly known as Smiling Sun) is USAID'S flagship NGO healthcare delivery program that provides primarily family planning and maternal, newborn and child health services to a catchment population of roughly 20 million. With recent DFID funding, the project expects to make major expansions in the urban component of the program by the end of the current phase in 2017. Health services are provided through 392 static clinics, over 10,000 satellite sessions and over 6,000 community health workers in urban as well as rural areas. Out of the total 207 static clinics in urban areas, 44 provide comprehensive emergency and obstetric care services while another six offer basic EmOc as of 2015.
 
3
Urban Primary Health Care Project (UPHCP) Phases 1 (1998–2005) and 2 (2005–2011) were initially funded by ADB, SIDA, DFID and UNFPA operating in 6 City Corporations and 5 Municipalities. At least 30 % of contacts are targeted towards the poor. The project contracts out primary healthcare services to local selected NGOs just like Smiling Sun does. The current Phase 3 (2012–2017) covers around ten million in urban areas through a network of 25 Comprehensive Reproductive Health care Centers, 112 Primary Heath Care Centers and 224 satellite clinics.
 
4
MANOSHI is a community based program implemented by BRAC which provides a comprehensive package of essential services for maternal, newborn and child health in urban slums. The total anticipated coverage was eight million across all slums in Dhaka Metropolitan Area by 2009 and the program currently covers all nine City Corporations of the country. The model deploys two kinds of health workers in the community -Shastho Shebika or community workers and Shastho Kormis who are equipped with mobile phone based data collection software. Medical doctors then provide feedback on the information collected by Shastho Kormis on mothers and children. In addition, birthing huts were set up in slums. The system relies on quick action on maternal health emergencies. Evaluation of the initial 2007–2011 phase revealed that the percentage of institutional deliveries (including in BRAC birthing huts) increased from 15 to 59 % in project areas and from 25 to 28 % in comparison areas.
 
5
Marie Stopes, an affiliate of Marie Stopes International (MSI) started operating in Bangladesh in 1988. Today, MSI’s program in the country is one of the largest in the MSI global partnership with 144 clinics in addition to outreach sites and mobile services covering 62 out of 64 districts in the country. The MSI clinics provide sexual and reproductive health services to 1.4 million Bangladeshis each year. It operates 141 clinics in urban and peri-urban areas out of which 15 provide maternal services including deliveries by C-section.
 
6
Patterns in use levels and equity for SBA are very similar to that for facility deliveries presented in this paper.
 
7
Deliveries in BRAC birthing huts are not attended by a SBA, however, given that these birthing huts are not staffed by medically trained practitioners.
 
Literature
1.
Gill Z, Ahmed JU. Experience from Bangladesh: implementing emergency obstetric care as part of the reproductive health agenda. Int J Gynecology and Obstetrics. 2004;85(2):213–30.CrossRef
2.
3.
McCarthy J, Maine D. A Framework for Analyzing the Determinants of Maternal Mortality. Stud Fam Plann. 1992;23:23–33.CrossRefPubMed
4.
National Institute of Population Research and Training (NIPORT), Mitra and Associates, & ICF International. Bangladesh Demographic and Health Survey 2014: Key Indicators. Dhaka, Bangladesh, and Rockville, Maryland USA: NIPORT, Mitra and Associates, & ICF International; 2015.
5.
Liang J, Zhu J, Zeng J, Li X, Zeng W, Li Q, et al. Preventable maternal mortality: Geographical/rural–urban differences and associated factors from the population based maternal mortality surveillance system in China. BMC Public Health. 2011;11:243.PubMedCentralCrossRefPubMed
6.
Sannevig L, Trygg N, Saxena D, Mavalankar D, Thomsen S. Inequity in India: the case of maternal and reproductive health. Global Health Action. 2013;6:19145.
7.
Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs. 2008;61(3):244–60.CrossRefPubMed
8.
Kongsri S, Limwattananon S, Sirilak S, Pralongsai P, Tangcharoensathien V. Equity of access to and utilization of reproductive health services in Thailand: national Reproductive Health Survey, 2006 and 2009. Reprod Health Matters. 2011;19(37):86–97.CrossRefPubMed
9.
10.
Chowdury ME, Ronsman C, Killewo J, Anwar I, Gausia K, Das-Gupta S, et al. Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study. Lancet. 2006;367:327–32.CrossRef
11.
Anwar I, Sami M, Akhtar A, Chowdhury M, Salma U, Rahman M. Inequity in maternal health care services: evidence from home based skilled-birth-attendant programmes in Bangladesh. Bulletin of World Health Organization. 2008;86(4):252–9.CrossRef
12.
13.
Adams AM, Islam R, Ahmed T. Who serves the urban poor? A geospatial and descriptive analysis of health services in slum settlements in Dhaka Bangladesh. Health Policy Plan. 2015;30:32–45.CrossRef
14.
National Institute for Population Research and Training (NIPORT), MEASURE Evaluation, International Centre for Diarrheal Diseases Research (icddr,b). Bangladesh Maternal Mortality and Health Care Survey 2010. Dhaka, Bangladesh: NIPORT, MEASURE Evaluation, & icddr,b; 2012.
15.
Filmer D, Pritchett L. Estimating Wealth Effects Without Expenditure Data - or Tears. An Application to Educational Enrollments in States of India. Demography. 2011;38(1):115–32.
16.
Baqui AH, Rosecrans AM, Williams EK, Agrawal PK, Ahmed S, Darmstadt GL, et al. NGO facilitation of a government community-based maternal and neonatal health programme in rural India: improvements in equity. Health Policy Plan. 2008;23(4):234–43.CrossRefPubMed
17.
Quayyum Z, Khan MN, Quayyum T, Nasreen H, Chowdhury M, Ensor T. Can community level interventions have an impact on equity and utilization of maternal health care - Evidence from rural Bangladesh. Int J Equity Health. 2013;12:22.PubMedCentralCrossRefPubMed
18.
National Institute of Population Research and Training (NIPORT), Associated for Community and Population Research (ACPR), & ICF International. Bangladesh Health Facility Survey 2014: Preliminary Findings. Dhaka, Bangladesh, and Rockville, Maryland USA: NIPORT, ACPR, & ICF International; 2015.
19.
National Institute for Population Research and Training (NIPORT), International Centre for Diarrheal Disease Research (icddr,b), & MEASURE Evaluation. Bangladesh Urban Health Survey 2013 Final Report. Dhaka, Bangladesh and Chapel Hill, North Carolina USA: NIPORT, icddr,b, & MEASURE Evaluation; 2015.
20.
Ahmed S, Khan MM. Is demand side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh. Soc Sci Med. 2011;72(10):1704–10.CrossRefPubMed
21.
Brugh K, Angeles G. Analysis of Maternal Health Expenditures by Services Received, Poverty Status, and Divisions. Chapel Hill, USA: Carolina Population Center, University of North Carolina; 2014. Working paper.
22.
Misra R, Chatterjee R, Rao S. India Health Report. New Delhi: Oxford University Press; 2003.
23.
El Arifeen S, Hill K, Ahsan KZ, Jamil K, Nahar Q, Streatfield PK. Maternal mortality in Bangladesh: a Countdown to 2015 country case study. Lancet. 2014;384(9951):1366–74.CrossRefPubMed
Metadata
Title
Trends in equity in use of maternal health services in urban and rural Bangladesh
Authors
Nahid Kamal
Sian Curtis
Mohammad S. Hasan
Kanta Jamil
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-016-0311-2

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