Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study
Abstract Background Equity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of ante...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-05-01
|
| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12939-018-0778-0 |
| _version_ | 1818450563611754496 |
|---|---|
| author | Aye Nyein Moe Myint Tippawan Liabsuetrakul Thein Thein Htay Myint Myint Wai Johanne Sundby Espen Bjertness |
| author_facet | Aye Nyein Moe Myint Tippawan Liabsuetrakul Thein Thein Htay Myint Myint Wai Johanne Sundby Espen Bjertness |
| author_sort | Aye Nyein Moe Myint |
| collection | DOAJ |
| description | Abstract Background Equity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of antenatal and delivery care have been reported in many countries, but have not yet been studied in Myanmar. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar. Methods A community-based cross-sectional survey using multistage sampling was conducted from October to November 2016. A wealth index was selected as the main socioeconomic parameter for measuring inequities with respect to early initiation of antenatal care (ANC), number of antenatal care visits, delivery by a skilled birth attendant (SBA) and delivery by cesarean section (CS). Inequities were evaluated using concentration curves and concentration indexes. Results Of the 762 women who gave birth within the 12-month survey period, there was no evidence of inequity in utilization of ANC; however, inequity of at least one antenatal visit among women aged less than 20 years was found with a concentration index of 0.04. The concentration indexes for delivery by SBA and CS were 0.05 and 0.14, respectively. Delivery by CS was disproportionately higher in adolescents and women with higher education than middle school. Conclusion There was no overall inequity in the utilization of ANC but substantial inequities in delivery by CS and SBA were shown. Social determinants of health, particularly age and education, were associated with inequities in the utilization of delivery care. Adolescent pregnant women were found to be particularly vulnerable, and thus should be a target group for strategic plans to reduce inequities in utilization of delivery care. |
| first_indexed | 2024-12-14T20:53:18Z |
| format | Article |
| id | doaj.art-b7293cd15c7143458c2e631df125e3df |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-12-14T20:53:18Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-b7293cd15c7143458c2e631df125e3df2022-12-21T22:47:45ZengBMCInternational Journal for Equity in Health1475-92762018-05-011711910.1186/s12939-018-0778-0Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional studyAye Nyein Moe Myint0Tippawan Liabsuetrakul1Thein Thein Htay2Myint Myint Wai3Johanne Sundby4Espen Bjertness5International Relations Division, Ministry of Health and SportsEpidemiology Unit, Faculty of Medicine, Prince of Songkla UniversityMinistry of Health and SportsDepartment of Medical Services (Planning), Ministry of Health and SportsDepartment of Community Medicine and Global Health, University of OsloDepartment of Community Medicine and Global Health, University of OsloAbstract Background Equity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of antenatal and delivery care have been reported in many countries, but have not yet been studied in Myanmar. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar. Methods A community-based cross-sectional survey using multistage sampling was conducted from October to November 2016. A wealth index was selected as the main socioeconomic parameter for measuring inequities with respect to early initiation of antenatal care (ANC), number of antenatal care visits, delivery by a skilled birth attendant (SBA) and delivery by cesarean section (CS). Inequities were evaluated using concentration curves and concentration indexes. Results Of the 762 women who gave birth within the 12-month survey period, there was no evidence of inequity in utilization of ANC; however, inequity of at least one antenatal visit among women aged less than 20 years was found with a concentration index of 0.04. The concentration indexes for delivery by SBA and CS were 0.05 and 0.14, respectively. Delivery by CS was disproportionately higher in adolescents and women with higher education than middle school. Conclusion There was no overall inequity in the utilization of ANC but substantial inequities in delivery by CS and SBA were shown. Social determinants of health, particularly age and education, were associated with inequities in the utilization of delivery care. Adolescent pregnant women were found to be particularly vulnerable, and thus should be a target group for strategic plans to reduce inequities in utilization of delivery care.http://link.springer.com/article/10.1186/s12939-018-0778-0InequityWealth indexConcentration indexAntenatal careDelivery care |
| spellingShingle | Aye Nyein Moe Myint Tippawan Liabsuetrakul Thein Thein Htay Myint Myint Wai Johanne Sundby Espen Bjertness Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study International Journal for Equity in Health Inequity Wealth index Concentration index Antenatal care Delivery care |
| title | Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study |
| title_full | Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study |
| title_fullStr | Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study |
| title_full_unstemmed | Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study |
| title_short | Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study |
| title_sort | inequity in the utilization of antenatal and delivery care in yangon region myanmar a cross sectional study |
| topic | Inequity Wealth index Concentration index Antenatal care Delivery care |
| url | http://link.springer.com/article/10.1186/s12939-018-0778-0 |
| work_keys_str_mv | AT ayenyeinmoemyint inequityintheutilizationofantenatalanddeliverycareinyangonregionmyanmaracrosssectionalstudy AT tippawanliabsuetrakul inequityintheutilizationofantenatalanddeliverycareinyangonregionmyanmaracrosssectionalstudy AT theintheinhtay inequityintheutilizationofantenatalanddeliverycareinyangonregionmyanmaracrosssectionalstudy AT myintmyintwai inequityintheutilizationofantenatalanddeliverycareinyangonregionmyanmaracrosssectionalstudy AT johannesundby inequityintheutilizationofantenatalanddeliverycareinyangonregionmyanmaracrosssectionalstudy AT espenbjertness inequityintheutilizationofantenatalanddeliverycareinyangonregionmyanmaracrosssectionalstudy |