The study explores inequalities in the utilization of delivery care services in different administrative divisions in Bangladesh, by key socioeconomic factors. It estimates the extent of the relationship between women’s socioeconomic inequalities and their place of delivery during 2004 and 2007. Trends in relation to place of delivery in relation to residency and education over a period of thirteen years (1993-2007) have also been measured. The study analyzed the trends and patterns in utilization of institutional delivery care among mothers, using data from the Bangladesh Demographic Health Survey (BDHS) conducted during 1993-2007. The data was disaggregated by area of residence in different divisions in Bangladesh. Bi-variate analyses, concentration curves and multivariate logistic regression were employed in the analysis of the data. The study indicated slow progress in the utilization of institutional delivery care among mothers in Bangladesh between 1993 and 2007. Large variations in outcome measures were observed among the different divisions. Multivariate analyses suggested growing inequalities in utilization of delivery care services between different economic groups and parents with different educational levels. The use of institutional delivery care remains substantially lower among poor and less educated rural mothers in Bangladesh, irrespective of age and employment. Further studies are recommended to explore the specific causes relating to the non-utilization of institutional delivery care.
WHO (2008) Maternal mortality fact sheet. http://www.who.int/making_pregnancy_safer/events/2008/mdg5/factsheet_maternal_mortality.pdf
Paruzzolo, S., Mehra, R., Kes, A. and Ashbaugh, C. (2010) Targeting poverty and gender inequality to improve maternal health solutions for girls and women. 2nd Global Conference, Washington DC, New York, 7-9 June 2010.
Ahmed, S., Creanga, A.A., Gillespie, D.G. and Tsui, A.O. (2010) Economic status, education and empowerment: Implications for maternal health service utilization in developing countries. PLoS One, 23, e11190.
Rahman, M.H., Mosley, W.H., Ahmed, S. and Akhter, H.H. (2008) Does service accessibility reduce socioeconomic differentials in maternity care seeking? Evidence from rural Bangladesh. Journal of Biosocial Science, 40, 19-33. doi:10.1017/S0021932007002258
Houweling, J., Ronsmans, C., Campbell, O.M.R. and Kunst, A.E. (2007) Huge poor rich inequalities in maternity and child care in developing countries. Bulletin of the World Health Organization, 85, 745-754.
WHO (2003) Bangladesh: Skilled birth attendant. http://www.whoban.org/skill_birth_training.html
UNDP (2010) Bangladesh. MDGs and Bangladesh. http://www.undp.org.bd/mdgs.php
Colin, S.M., Anwar, I. and Ronsmans, C. (2007) A decade of inequality in maternity care: Antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991-2004). International Journal for Equity in Health, 30, 6-9.
Islam, M.T., Hossain, M.M., Islam, M.A. and Haque, Y.A. (2005) Improvement of coverage and utilization of EmOC services in southwestern Bangladesh. International Journal of Gynecology & Obstetrics, 91, 298-305. doi:10.1016/j.ijgo.2005.06.029
National Institute of Population Research and Training (NIPROT). ORC Macro. (2002) Bangladesh maternal health services and maternal mortality survey 2001. NIPORT, Dhaka.
Islam, M.A., Chowdhury, R.I. and Akhter, H.H. (2006) Complications during pregnancy, delivery, and postnatal stages and place of delivery in rural Bangladesh. Health Care for Women International, 27, 807-821. doi:10.1080/07399330600880368
Bangladesh Demographic and Health Survey 2007. http://www.measuredhs.com/pubs/pdf/FR207/FR207%5BApril-10-2009%5D.pdf
UNICEF. Bangladesh; health and nutrition; women’s health. http://www.unicef.org/bangladesh/health_nutrition_407.htm
Say, L. and Raine, R. (2007) A systematic review of inequalities in the use of maternal health care in developing countries: Examining the scale of the problem and the importance of context. Bulletin of the World Health Organization, 85, 812-819.
UNICEF. Maternal health in Bangladesh. http://www.unicef.org/bangladesh/MATERNAL_HEALTH.pdf
Gage, A.J. (2007) Barriers to the utilization of maternal health care in rural Mali. Social Science & Medicine, 65, 1666-1682. doi:10.1016/j.socscimed.2007.06.001
Navaneetham, K. and Dharmalingam, A. (2020) Utilization of maternal health care services in Southern India. Social Science & Medicine, 55, 1849-1869. doi:10.1016/S0277-9536(01)00313-6
Kunst, A.E. and Houweling, T. (2001) A global picture of poor-rich differences in the utilization of delivery care. Studies in Health Services Organization and Policy, 17, 297-316.
Ahmed, S. and Hill, K. (2011) Maternal mortality estimation at the sub national level: A model based method with an application to Bangladesh. Bulletin of the World Health Organization, 89, 12-21. doi:10.2471/BLT.10.076851
Anwar, I., Sami, M., Akhtar, N., Chowdhury, M.E., Salma, U., Rahman, M. and Koblinskya, M. (2008) Inequity in maternal health-care services: Evidence from home-based skilled-birth-attendant programmes in Bangladesh. Bulletin of the World Health Organization, 86, 252-259. doi:10.2471/BLT.07.042754
Hossain, M.I. (2010) Inequality in the utilization of maternal care and the impact of a macroeconomic policy: Evidence from Bangladesh. HEDG Working Paper 10/08, The University of York, York, 1-31.
Bangladesh Demographic and Health Survey (2004). http://www.measuredhs.com/countries/country_main.cfm?ctry_id=1&c=Bangladesh
Rutstein, S.O. and Johnson, K. (2004) The DHS wealth index. ORC Macro, Calverton, MD.
Dalal, K. (2011) Does economic empowerment protects women from intimate partner violence? Journal of Injury and Violence Research, 3, 35-44.
Dalal, K. and Lindqvist, K. (2010) A National study of the prevalence and correlates of domestic violence among women in India. Asia-Pacific Journal of Public Health, Nov 30. [Epub ahead of print]
Wagstaff, A. and van Doorslaer, E. (2003) Watanabe N. on decomposing the causes of health sector inequalities, with an application to malnutrition inequalities in Vietnam. Journal of Econometrics, 112, 219-227. doi:10.1016/S0304-4076(02)00161-6
O’Donnell, O., van Doorslaer, E., Wagstaff, A. and Lindelow, M. (2008) Analysing health equity using household survey data: A guide to techniques and their implementation, Washington DC. http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/EXTPAH/0,,contentMDK:20216933~menuPK:400482~pagePK:148956~piPK:216618~theSitePK:400476,00.html chapter link_ http://siteresources.worldbank.org/INTPAH/Resources/Publictions/459843-1195594469249/HealthEquityCh7.pdf
Iqbal, J.M. (2007) In defence of Marxism, Bangladesh and the crisis over the caretaker government. http://www.marxist.com/bangladesh-crisis-caretaker-government170107.htm
Ikeako, L.C., Onah, H.E. and Iloabachie, G.C. (2006) Influence of formal maternal education on the use of formal maternity services in Inagu, Nigeria. Journal of Obstetrics & Gynaecology, 26, 30-34. doi:10.1080/01443610500364004
Mekonnen, Y. and Mekonnen, A. (2003) Factors influencing the use of maternal health care services in Ethiopia. Journal of Health, Population and Nutrition, 21, 374-382.
Bangladesh Bureau of Educational Information and Statistics (2006). http://www.banbeis.gov.bd/bd_pro.htm
Nahar, S. and Costello, A. (1998) The hidden cost of “free” maternity care in Dhaka, Bangladesh. Health Policy Plan, 13, 417-422. doi:10.1093/heapol/13.4.417
Killingsworth, J.R., Hossain, N., Hedrick-Wong, Y., Thomas, S.D., Rahman, A. and Begum, T. (1999) Unofficial fees in Bangladesh: Price, equity and institutional issues. Health Policy Plan, 14, 152-163. doi:10.1093/heapol/14.2.152
Pathak, P.K., Singh, A. and Subramanian, S.V. 2010) Economic inequalities in maternal health care: Prenatal care and skilled birth attendance in India, 1992-2006. PLoS ONE, 27, e13593. doi:10.1371/journal.pone.0013593
Chakraborty, N., Islam, M.A., Chowdhury, R.I., Bari, W. and Akhter, H.H. (2003) Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International, 18, 327-337. doi:10.1093/heapro/dag414
Anwar, I., Kalim, N. and Koblinsky, M. (2009) Quality of obstetric care in public-sector facilities and constraints to implementing emergency obstetric care services: Evidence from high- and low-performing districts of Bangladesh. Journal of Health, Population and Nutrition, 27, 139-155. doi:10.3329/jhpn.v27i2.3327