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International Journal for Equity in Health

, 13:120

First Online: 10 December 2014Received: 04 August 2014Accepted: 26 November 2014DOI: 10.1186-s12939-014-0120-4

Cite this article as: Hajizadeh, M., Alam, N. & Nandi, A. Int J Equity Health 2014 13: 120. doi:10.1186-s12939-014-0120-4


BackgroundNotwithstanding the significant progress in reducing maternal mortality in recent years, social inequalities in the utilization of maternal care continue to be a challenge in Bangladesh. In this study, we aim to provide a comprehensive analysis of trends in social inequalities in utilization of antenatal care ANC, facility based delivery FBD, and skilled birth attendance SBA in Bangladesh between 1995 and 2010.

MethodsData were extracted from the five latest rounds of Bangladesh Demographic Health Surveys BDHS. The Theil index T and between-group variance BGV were used to calculate relative and absolute disparities in the utilization of three measures ANC, FBD, and SBA of maternal care across six administrative regions. The relative and slope indices of inequality RII and SII, respectively were also used to calculate wealth- and education-based inequality in the utilization of maternal care.

ResultsThe results of the T-index suggest that relative inequality in SBA has declined by 0.2% per year. Nevertheless, the estimated BGV demonstrated that absolute inequalities in all three measures of maternal care have increased across administrative divisions. For all three measures of maternal care, the RII and SII indicated consistent socioeconomic inequalities favouring wealthier and more educated women. The adjusted RII suggested that wealth- and education-related inequalities for ANC declined by 9% and 6%, respectively, per year during the study period. The adjusted SII, however, showed that wealth- and education-related inequalities for FBD increased by 0.6% per year.

ConclusionsAlthough socially disadvantaged mothers increased their utilization of care relative to mothers of higher socioeconomic status, the absolute gap in utilization of care between socioeconomic groups has increased over time. Our findings indicate that wealthier and more educated women, as well as those living in urban areas, are the major users of ANC, FBD and SBA in Bangladesh. Thus, priority focus should be given to implementing and evaluating interventions that benefit women who are poorer, less educated and live in rural areas.

KeywordsSocial inequality Maternal care utilization Absolute and relative inequalities Bangladesh Electronic supplementary materialThe online version of this article doi:10.1186-s12939-014-0120-4 contains supplementary material, which is available to authorized users.

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Autor: Mohammad Hajizadeh - Nazmul Alam - Arijit Nandi


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