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. 2024 Mar 18;14(3):e076646.
doi: 10.1136/bmjopen-2023-076646.

Socioeconomic inequalities in skilled attendance at birth and caesarean section rates in Myanmar 2015-2016: a cross-sectional study

Kyaw Lwin Show  1 , Thae Maung Maung  1 , George Disney  2 , Meghan A Bohren  3 , Pisake Lumbiganon  4 , Chetta Ngamjarus  5
Affiliations

Socioeconomic inequalities in skilled attendance at birth and caesarean section rates in Myanmar 2015-2016: a cross-sectional study

Kyaw Lwin Show et al. BMJ Open. .

Abstract

Objectives: This study aims to assess inequalities in skilled birth attendance and utilisation of caesarean section (CS) in Myanmar.

Study design: Cross-sectional study design.

Setting and population: We used secondary data from the Myanmar Demographic and Health Survey (2015-2016). Our outcome measures of skilled birth attendance and utilisation of CS were taken from the most recent birth of interviewed women. Absolute and relative inequalities across several sociodemographic characteristics were assessed and evaluated by calculating rate differences, rate ratio and concentration indexes.

Results: More than one-third (36%, 95% CI 32.5% to 39.4%) of women gave birth without a skilled birth attendant present at their most recent birth. 40.7% (95% CI 37.8% to 43.7%) gave birth in healthcare facilities, and the CS rate was 19.7% (95% CI 17.9% to 21.8%) for their most recent birth. The highest proportion of birth without a skilled provider was found in the hilly regions and rural residents, poorest and less educated women, and those with less than four antenatal care visits. Inequalities in birth without a skilled provider were observed across regions, place of residence, wealth quintile, education level and number of antenatal care taken. The highest rate of CS was found among plain regions and urban residents, richest women, more than secondary education, those with more than four antenatal care visits and in private health facilities. Inequalities in CS utilisation were observed across place of residence, wealth quintiles, education level, number of antenatal care taken and type of health facilities.

Conclusion: This study provides evidence regarding inequalities in maternal health service utilisation in Myanmar. Increasing maternal health service availability and accessibility, promoting quality of care and health education campaigns to increase maternal health services utilisation are recommended.

Keywords: Health Equity; PUBLIC HEALTH; REPRODUCTIVE MEDICINE.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Distribution of antenatal care (ANC) coverage, rate of birth in health facilities, SBA and caesarean section rate by region. SBA, skilled birth attendant.
Figure 2
Figure 2
Inequalities of antenatal care (ANC), skilled attendance at birth, birth in a health facility and caesarean section
Figure 3
Figure 3
Relative wealth-based and education-based inequality in mode and place of birth, represented using concentration curve. CIS, Concentration Index; CS, caesarean section; SBA, skilled birth attendant.
See this image and copyright information in PMC

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References

    1. World Health Organization . Trends In Maternal Mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva, 2019.
    1. Say L, Chou D, Gemmill A, et al. . Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014;2:e323–33. 10.1016/S2214-109X(14)70227-X - DOI - PubMed
    1. World Health Organization . WHO recommendations non-clinical interventions to reduce unnecessary caesarean sections. 2018. - PubMed
    1. Wang B, Zhou L, Coulter D, et al. . Effects of caesarean section on maternal health in low risk nulliparous women: a prospective matched cohort study in Shanghai, China. BMC Pregnancy Childbirth 2010;10:78. 10.1186/1471-2393-10-78 - DOI - PMC - PubMed
    1. Liu S, Liston RM, Joseph KS, et al. . Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007;176:455–60. 10.1503/cmaj.060870 - DOI - PMC - PubMed