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Trends and Inequities in Use of Maternal Health Care Services in Bangladesh, 1991-2011

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  • Iqbal Anwar
  • Herfina Y Nababan
  • Shabnam Mostari
  • Aminur Rahman
  • Jahangir A M Khan

Abstract

Background and Methods: Monitoring use-inequity is important to measure progress in efforts to address health-inequities. Using data from six Bangladesh Demographic and Health Surveys (BDHS), we examine trends, inequities and socio-demographic determinants of use of maternal health care services in Bangladesh between 1991 and 2011. Findings: Access to maternal health care services has improved in the last two decades. The adjusted yearly trend was 9.0% (8.6%-9.5%) for any antenatal care (ANC), 11.9% (11.1%-12.7%) for institutional delivery, and 18.9% (17.3%-20.5%) for C-section delivery which is above the WHO recommended rate of 5-15%. Use-inequity was significant for all three indicators but is reducing over time. Between 1991-1994 and 2007-2011 the rich:poor ratio reduced from 3.65 to 1.65 for ANC and from 15.80 to 6.77 for institutional delivery. Between 1995-1998 and 2007-2011, the concentration index reduced from 0.27 (0.25-0.29) to 0.15 (0.14-0.16) for ANC, and from 0.65 (0.60-0.71) to 0.39 (0.37-0.41) for institutional delivery during that period. For use of c-section, the rich:poor ratio reduced from 18.17 to 13.39 and the concentration index from 0.66 (0.57-0.75) to 0.47 (0.45-0.49). In terms of rich:poor differences, there was equity-gain for ANC but not for facility delivery or C-section delivery. All socio-demographic variables were significant predictors of use; of them, maternal education was the most powerful. In addition, the contribution of for-profit private sector is increasingly growing in maternal health. Conclusion: Both access and equity are improving in maternal health. We recommend strengthening ongoing health and non-health interventions for the poor. Use-inequity should be monitored using multiple indicators which are incorporated into routine health information systems. Rising C-section rate is alarming and indication of C-sections should be monitored both in private and public sector facilities.

Suggested Citation

  • Iqbal Anwar & Herfina Y Nababan & Shabnam Mostari & Aminur Rahman & Jahangir A M Khan, 2015. "Trends and Inequities in Use of Maternal Health Care Services in Bangladesh, 1991-2011," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-14, March.
    • Handle: RePEc:plo:pone00:0120309
    DOI: 10.1371/journal.pone.0120309
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    1. Syed Hasan & Tasnima Akter & Musharrat Jahan & Ashraf Dewan, 2023. "Proximity to healthcare centres and service use: The case of Community Clinics in Bangladesh," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 31(3), pages 819-849, July.
    2. Cinzia Di Novi & Harshita Thakare, 2022. "Inequality of Opportunity in Accessing Maternal and Newborn Healthcare Services: Evidence from the Bangladesh Demographic and Health Survey," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 164(3), pages 1505-1529, December.
    3. Haque, Md Rabiul & Parr, Nick & Muhidin, Salut, 2020. "The effects of household's climate-related displacement on delivery and postnatal care service utilization in rural Bangladesh," Social Science & Medicine, Elsevier, vol. 247(C).

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