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Decomposing the socioeconomic inequality in utilisation of maternal health-care services in selected Asian and sub-Saharan African countries
Meeting Abstracts
Decomposing the socioeconomic inequality in utilisation of maternal health-care services in selected Asian and sub-Saharan African countries Dipty Nawal, T V Sekher, Srinivas Goli
Abstract Background The persistence of socioeconomic-related inequality in health-care services has been extensively explored by scholars and researchers in developing countries, and policy has been endorsed. This paper locates the current existing reality of four developing countries, which lag behind in achieving the fifth Millennium Development Goal. The countries studied are Bangladesh, Ethiopia, Nepal, and Zimbabwe. The principal objective is to estimate socioeconomic inequality in the utilisation of maternal health-care services and propose individual-level policies to improve utilisation and a more equitable distribution of health services. Methods An approved method of Wagstaff inequality decomposition (concentration index [CI] and decomposition of CI) has been operationalised with recently released Demographic and Health Survey data (2010–11) for inequality analysis. Findings The estimated value of the CI is negative in all selected countries with fewer than three antenatal care (ANC) visits (CI –0·1147, –0·1146, –0·2859, –0·0637), no institutional delivery (–0·1333, –0·0925, –0·1959, –0·2527), and no postnatal care within 2 days of delivery (–0·2468, –0·0370, –0·1816, –0·0577) for Bangladesh, Ethiopia, Nepal, and Zimbabwe, respectively. CI estimation shows that health inequality is more concentrated on economically poor people, but the strength of the association varies between countries. Results of decomposition analyses indicate that the critical factor contributing to disparity in the number of ANC visits is the poor economic status of the household (41% [95% CI 37·5–44·5], 31% [28–34], and 68% [64–72], respectively, excluding Bangladesh). However, place of residence was the major contributor for delivery outside of a health-care setting (10% [7·3–12·7], 58% [50·2–66·4], 20% [16·4–23·7], 34% [30–38]). For postnatal care, the absolute level of association is greater with birth order 3+ (β=0·1748) in Nepal and with no institutional delivery (β=0·7100) in Bangladesh. Similarly, the result of proportional contribution also shows that the rural place of residence contributes 40% (37–43) of the total inequalities, followed by no institutional delivery (38% [33·5–42·5]) and poor economic status (17% [15–19·5]) in Zimbabwe.
Published Online June 17, 2013 International Institute for Population Sciences, Mumbai, Maharashtra, India (D Nawal MPhil, T V Sekher PhD); and Giri Institute of Development Studies, Lucknow, Uttar Pradesh, India (S Goli MPS) Correspondence to: Dipty Nawal, International Institute for Population Sciences, Govandi Station Road, Mumbai, pin 400088, Mumbai, Maharashtra, India [email protected]
Interpretation Household economic status emerges as a dominant contributor of inequalities in health-care access. However, individual-level factors should be considered in order to improve overall maternal health-care services in selected countries. Funding This research is the authors’ independent work and was not funded by any person or organisation. The data used in this paper are in the public domain. Access to these data is available to all researchers. Contributors DN and TVS conceptualised the study and gathered background information. DN and SG constructed the concentration index and performed the decomposition analysis. DN compiled data and prepared the draft. TVS revised and finalised the draft. Conflicts of interest We declare that we have no conflicts of interest.
www.thelancet.com
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Decomposing the socioeconomic inequality in utilisation of maternal health-care services in selected Asian and sub-Saharan African countries Dipty Nawal, T V Sekher, Srinivas Goli
Abstract Background The persistence of socioeconomic-related inequality in health-care services has been extensively explored by scholars and researchers in developing countries, and policy has been endorsed. This paper locates the current existing reality of four developing countries, which lag behind in achieving the fifth Millennium Development Goal. The countries studied are Bangladesh, Ethiopia, Nepal, and Zimbabwe. The principal objective is to estimate socioeconomic inequality in the utilisation of maternal health-care services and propose individual-level policies to improve utilisation and a more equitable distribution of health services. Methods An approved method of Wagstaff inequality decomposition (concentration index [CI] and decomposition of CI) has been operationalised with recently released Demographic and Health Survey data (2010–11) for inequality analysis. Findings The estimated value of the CI is negative in all selected countries with fewer than three antenatal care (ANC) visits (CI –0·1147, –0·1146, –0·2859, –0·0637), no institutional delivery (–0·1333, –0·0925, –0·1959, –0·2527), and no postnatal care within 2 days of delivery (–0·2468, –0·0370, –0·1816, –0·0577) for Bangladesh, Ethiopia, Nepal, and Zimbabwe, respectively. CI estimation shows that health inequality is more concentrated on economically poor people, but the strength of the association varies between countries. Results of decomposition analyses indicate that the critical factor contributing to disparity in the number of ANC visits is the poor economic status of the household (41% [95% CI 37·5–44·5], 31% [28–34], and 68% [64–72], respectively, excluding Bangladesh). However, place of residence was the major contributor for delivery outside of a health-care setting (10% [7·3–12·7], 58% [50·2–66·4], 20% [16·4–23·7], 34% [30–38]). For postnatal care, the absolute level of association is greater with birth order 3+ (β=0·1748) in Nepal and with no institutional delivery (β=0·7100) in Bangladesh. Similarly, the result of proportional contribution also shows that the rural place of residence contributes 40% (37–43) of the total inequalities, followed by no institutional delivery (38% [33·5–42·5]) and poor economic status (17% [15–19·5]) in Zimbabwe.
Published Online June 17, 2013 International Institute for Population Sciences, Mumbai, Maharashtra, India (D Nawal MPhil, T V Sekher PhD); and Giri Institute of Development Studies, Lucknow, Uttar Pradesh, India (S Goli MPS) Correspondence to: Dipty Nawal, International Institute for Population Sciences, Govandi Station Road, Mumbai, pin 400088, Mumbai, Maharashtra, India [email protected]
Interpretation Household economic status emerges as a dominant contributor of inequalities in health-care access. However, individual-level factors should be considered in order to improve overall maternal health-care services in selected countries. Funding This research is the authors’ independent work and was not funded by any person or organisation. The data used in this paper are in the public domain. Access to these data is available to all researchers. Contributors DN and TVS conceptualised the study and gathered background information. DN and SG constructed the concentration index and performed the decomposition analysis. DN compiled data and prepared the draft. TVS revised and finalised the draft. Conflicts of interest We declare that we have no conflicts of interest.
www.thelancet.com
97