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. 2007 Aug 30:6:9.
doi: 10.1186/1475-9276-6-9.

A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991-2004)

Simon M Collin  1 , Iqbal Anwar, Carine Ronsmans
Affiliations

A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991-2004)

Simon M Collin et al. Int J Equity Health. .

Abstract

Background: Bangladesh is committed to the fifth Millennium Development Goal (MDG-5) target of reducing its maternal mortality ratio by three-quarters between 1990 and 2015. Since the early 1990s, Bangladesh has followed a strategy of improving access to facilities equipped and staffed to provide emergency obstetric care (EmOC).

Methods: We used data from four Demographic and Health Surveys conducted between 1993 and 2004 to examine trends in the proportions of live births preceded by antenatal consultation, attended by a health professional, and delivered by caesarean section, according to key socio-demographic characteristics.

Results: Utilization of antenatal care increased substantially, from 24% in 1991 to 60% in 2004. Despite a relatively greater increase in rural than urban areas, utilization remained much lower among the poorest rural women without formal education (18%) compared with the richest urban women with secondary or higher education (99%). Professional attendance at delivery increased by 50% (from 9% to 14%, more rapidly in rural than urban areas), and caesarean sections trebled (from 2% to 6%), but these indicators remained low even by developing country standards. Within these trends there were huge inequalities; 86% of live births among the richest urban women with secondary or higher education were attended by a health professional, and 35% were delivered by caesarean section, compared with 2% and 0.1% respectively of live births among the poorest rural women without formal education. The trend in professional attendance was entirely confounded by socioeconomic and demographic changes, but education of the woman and her husband remained important determinants of utilization of obstetric services.

Conclusion: Despite commendable progress in improving uptake of antenatal care, and in equipping health facilities to provide emergency obstetric care, the very low utilization of these facilities, especially by poor women, is a major impediment to meeting MDG-5 in Bangladesh.

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Figures

Figure 1
Figure 1
Maternal health care in Bangladesh, 1991–2004.
Figure 2
Figure 2
Maternal health care in Bangladesh by asset quintile (1991–2004).
See this image and copyright information in PMC

References

    1. The Millennium Development Goals Report. New York , United Nations; 2006.
    1. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368:1284–1299. doi: 10.1016/S0140-6736(06)69381-1. - DOI - PubMed
    1. Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, van Lerberghe W. Going to scale with professional skilled care. Lancet. 2006;368:1377–1386. - PubMed
    1. Gwatkin DR, Bhuiya A, Victora CG. Making health systems more equitable. Lancet. 2004;364:1273–1280. doi: 10.1016/S0140-6736(04)17145-6. - DOI - PubMed
    1. Kunst AE, Houweling T. A global picture of poor-rich differences in the utilisation of delivery care. Studies in Health Services Organisation and Policy. 2001;17:297–316.

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