Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017–2018
Abstract Background Inequality in maternal health has remained a challenge in many low-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilization of maternal healthcare services for Bangladesh and Pakistan. Methods The study used t...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Reproductive Health |
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| Online Access: | https://doi.org/10.1186/s12978-023-01595-y |
| _version_ | 1827983941651398656 |
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| author | Farjana Misu Khurshid Alam |
| author_facet | Farjana Misu Khurshid Alam |
| author_sort | Farjana Misu |
| collection | DOAJ |
| description | Abstract Background Inequality in maternal health has remained a challenge in many low-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilization of maternal healthcare services for Bangladesh and Pakistan. Methods The study used the latest Demographic Health Surveys (DHS, 2017–2018) datasets of Bangladesh and Pakistan for women aged 15–49 years who had given at least one live birth in three years preceding the survey. Equity strata were identified from the literature and conformed by binary logistic regressions. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI) and the slope index of inequality (SII) were calculated to measure inequalities in the utilization of four maternal healthcare services. For two-categories equity strata, rate ratio (RR), and rate difference (RD) were calculated. Concentration curves and equiplots were constructed to visually demonstrate inequality in maternal healthcare services. Results In Bangladesh, there was greater inequality in skilled birth attendance (SBA) based on wealth (RCI: 0.424, ACI: 0.423, and SII: 0.612), women’s education (RCI: 0.380, ACI: 0.379 and SII: 0.591), husband’s education (RCI: 0.375, ACI: 0.373 and SII: 0.554) and birth order (RCI: − 0.242, ACI: − 0.241, and SII: -0.393). According to RCI, ACI, and SII, there was inequality in Pakistan for at least four ANC visits by the skilled provider based on wealth (RCI: 0.516, ACI: 0.516 and SII: 0.738), women’s education (RCI: 0.470, ACI: 0.470 and SII: 0.757), and husband’s education (RCI: 0.380, ACI: 0.379 and SII: 0.572). For Bangladesh, the RR (1.422) and RD (0.201) imply more significant urban–rural inequality in SBA. In Pakistan, urban–rural inequality was greater for at least four ANC visits by the skilled provider (RR: 1.650 and RD 0.279). Conclusion Inequality in maternal healthcare is greater among the underprivileged group in Pakistan than in Bangladesh. In Bangladesh, the SBA is the most inequitable maternal healthcare, while for Pakistan it is at least four ANC visits by the skilled provider. Customized policies based on country context would be more effective in bridging the gap between the privileged and underprivileged groups. |
| first_indexed | 2024-04-09T22:54:10Z |
| format | Article |
| id | doaj.art-ab168fd27223457ea38aa08f24f44edc |
| institution | Directory Open Access Journal |
| issn | 1742-4755 |
| language | English |
| last_indexed | 2024-04-09T22:54:10Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Reproductive Health |
| spelling | doaj.art-ab168fd27223457ea38aa08f24f44edc2023-03-22T11:23:31ZengBMCReproductive Health1742-47552023-03-0120111710.1186/s12978-023-01595-yComparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017–2018Farjana Misu0Khurshid Alam1Murdoch Business School, Murdoch UniversityMurdoch Business School, Murdoch UniversityAbstract Background Inequality in maternal health has remained a challenge in many low-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilization of maternal healthcare services for Bangladesh and Pakistan. Methods The study used the latest Demographic Health Surveys (DHS, 2017–2018) datasets of Bangladesh and Pakistan for women aged 15–49 years who had given at least one live birth in three years preceding the survey. Equity strata were identified from the literature and conformed by binary logistic regressions. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI) and the slope index of inequality (SII) were calculated to measure inequalities in the utilization of four maternal healthcare services. For two-categories equity strata, rate ratio (RR), and rate difference (RD) were calculated. Concentration curves and equiplots were constructed to visually demonstrate inequality in maternal healthcare services. Results In Bangladesh, there was greater inequality in skilled birth attendance (SBA) based on wealth (RCI: 0.424, ACI: 0.423, and SII: 0.612), women’s education (RCI: 0.380, ACI: 0.379 and SII: 0.591), husband’s education (RCI: 0.375, ACI: 0.373 and SII: 0.554) and birth order (RCI: − 0.242, ACI: − 0.241, and SII: -0.393). According to RCI, ACI, and SII, there was inequality in Pakistan for at least four ANC visits by the skilled provider based on wealth (RCI: 0.516, ACI: 0.516 and SII: 0.738), women’s education (RCI: 0.470, ACI: 0.470 and SII: 0.757), and husband’s education (RCI: 0.380, ACI: 0.379 and SII: 0.572). For Bangladesh, the RR (1.422) and RD (0.201) imply more significant urban–rural inequality in SBA. In Pakistan, urban–rural inequality was greater for at least four ANC visits by the skilled provider (RR: 1.650 and RD 0.279). Conclusion Inequality in maternal healthcare is greater among the underprivileged group in Pakistan than in Bangladesh. In Bangladesh, the SBA is the most inequitable maternal healthcare, while for Pakistan it is at least four ANC visits by the skilled provider. Customized policies based on country context would be more effective in bridging the gap between the privileged and underprivileged groups.https://doi.org/10.1186/s12978-023-01595-yInequalityMaternal healthcareBangladeshPakistan |
| spellingShingle | Farjana Misu Khurshid Alam Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017–2018 Reproductive Health Inequality Maternal healthcare Bangladesh Pakistan |
| title | Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017–2018 |
| title_full | Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017–2018 |
| title_fullStr | Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017–2018 |
| title_full_unstemmed | Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017–2018 |
| title_short | Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017–2018 |
| title_sort | comparison of inequality in utilization of maternal healthcare services between bangladesh and pakistan evidence from the demographic health survey 2017 2018 |
| topic | Inequality Maternal healthcare Bangladesh Pakistan |
| url | https://doi.org/10.1186/s12978-023-01595-y |
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