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“Can community level interventions have an impact on equity and utilization of maternal health care” – Evidence from rural Bangladesh

Zahidul Quayyum1*, Mohammad Nasir Uddin Khan2, Tasmeen Quayyum2, Hashima E Nasreen2, Morseda Chowdhury3 and Tim Ensor4

Author Affiliations

1 Health Economic Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK

2 Research and Evaluation Division, Brac. 75 Mohakhali, Dhaka, Bangladesh

3 Health, Nutrition and Population Programme, Brac. 75 Mohakhali, Dhaka, Bangladesh

4 Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK

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International Journal for Equity in Health 2013, 12:22  doi:10.1186/1475-9276-12-22

Published: 2 April 2013

Abstract

Background

Evidence from low and middle income countries (LMICs) suggests that maternal mortality is more prevalent among the poor whereas access to maternal health services is concentrated among the rich. In Bangladesh substantial inequities exist both in the use of facility-based basic obstetric care and for home births attended by skilled birth attendant. BRAC initiated an intervention on Improving Maternal, Neonatal, and Child Survival (IMNCS) in the rural areas of Bangladesh in 2008. One of the objectives of the intervention is to improve the utilization of maternal and child health care services among the poor. This study aimed to look at the impact of the intervention on utilization and also on equity of access to maternal health services.

Methods

A quasi-experimental pre-post comparison study was conducted in rural areas of five districts comprising three intervention (Gaibandha, Rangpur and Mymensingh) and two comparison districts (Netrokona and Naogaon). Data on health seeking behaviour for maternal health were collected from a repeated cross sectional household survey conducted in 2008 and 2010.

Results

Results show that the intervention appears to cause an increase in the utilization of antenatal care. The concentration index (CI) shows that this has become pro-poor over time (from CI: 0.30 to CI: 0.04) in the intervention areas. In contrast the use of ANC from medically trained providers has become pro-rich (from, CI: 0.18 to CI: 0.22). There was a significant increase in the utilisation of trained attendants for home delivery in the intervention areas compared to the comparison areas and the change was found to be pro-poor. Use of postnatal care cervices was also found to be pro-poor (from CI: 0.37 to CI: 0.14). Utilization of ANC services provided by medically trained provider did not improve in the intervention area. However, where the intervention had a positive effect on utilization it also seemed to have had a positive effect on equity.

Conclusions

To sustain equity in health care utilization, the IMNCS programme needs to continue providing free home based services. In addition to this, the programme should also continue to provide funding to bear the cost to those mothers who are not able to have the comprehensive ANC from medically trained providers.