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. 2017 Jul 25;12(7):e0181408.
doi: 10.1371/journal.pone.0181408. eCollection 2017.

Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh

Mohammad Rifat Haider  1   2 , Mohammad Masudur Rahman  3 , Md Moinuddin  3 , Ahmed Ehsanur Rahman  3 , Shakil Ahmed  4 , M Mahmud Khan  1
Affiliations

Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh

Mohammad Rifat Haider et al. PLoS One. .

Abstract

Background: Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization.

Method: Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index.

Results: Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370).

Conclusions: Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups. Maternal health programs, if properly designed and implemented, can improve access, partially overcoming the negative effects of socioeconomic disparities.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Program districts under MNHIB and comparison districts from BDHS.
Fig 2
Fig 2. Rich-poor ratio in maternal health indicators by study period.
Fig 3
Fig 3. Concentration curves of maternal and neonatal healthcare utilizations by study period.
See this image and copyright information in PMC

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