Equity in maternal and child health in Thailand

• Published in: Bulletin of the World Health Organization 2010-06, Vol.88 (6), p.420-427
• Main Authors: LIMWATTANANON, Supon, TANGCHAROENSATHIEN, Viroj, PRAKONGSAI, Phusit
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Biological and medical sciences; Birth weight; Caregivers; Children & youth; Childrens health; Clusters; Cross-Sectional Studies; Diarrhea; Education; Educational Status; Families & family life; Family planning; Female; General aspects; Geography; Health; Health care expenditures; Health Care Surveys; Health facilities; Health services; Health Services Accessibility - statistics & numerical data; Health Services Needs and Demand; Health Status Disparities; Households; Humans; Illnesses; Immunization; Indicators; Infant; Infant Welfare - statistics & numerical data; Male; Malnutrition; Malnutrition - epidemiology; Maternal & child health; Maternal Welfare - statistics & numerical data; Medical sciences; Medical service; Middle Aged; Miscellaneous; Mothers; Non theme issue; Organizations; Pneumonia; Prenatal care; Prevalence; Principal components analysis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rural; Socioeconomic Factors; Teenage pregnancy; Thailand; Thailand - epidemiology; Treatment Outcome; Universal Health Insurance - statistics & numerical data; Vaccines; Womens health; Young Adult
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.09.068791

To assess equity in health outcomes and interventions for maternal and child health (MCH) services in Thailand. Women of reproductive age in 40 000 nationally representative households responded to the Multiple Indicator Cluster Survey in 2005-2006. We used a concentration index (CI) to assess distribution of nine MCH indicator groups across the household wealth index. For each indicator we also compared the richest and poorest quintiles or deciles, urban and rural domiciles, and mothers or caregivers with or without secondary school education. CHILD UNDERWEIGHT (CI: -0.2192; P < 0.01) and stunting (CI: -0.1767; P < 0.01) were least equitably distributed, being disproportionately concentrated among the poor; these were followed by teenage pregnancy (CI: -0.1073; P < 0.01), and child pneumonia (CI: -0.0896; P < 0.05) and diarrhoea (CI: -0.0531; P < 0.1). Distribution of the MCH interventions was fairly equitable, but richer women were more likely to receive prenatal care and delivery by a skilled health worker or in a health facility. The most equitably distributed interventions were child immunization and family planning. All undesirable health outcomes were more prevalent among rural residents, although the urban-rural gap in MCH services was small. Where mothers or caregivers had no formal education, all outcome indicators were worse than in the group with the highest level of education. Equity of coverage in key MCH services is high throughout Thailand. Inequitable health outcomes are largely due to socioeconomic factors, especially differences in the educational level of mothers or caregivers.