Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study

• Published in: International journal for equity in health 2018-05, Vol.17 (1), p.63-63, Article 63
• Main Authors: Myint, Aye Nyein Moe, Liabsuetrakul, Tippawan, Htay, Thein Thein, Wai, Myint Myint, Sundby, Johanne, Bjertness, Espen
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Adult; Antenatal care; Birth; Budgets; Care and treatment; Cesarean section; Cesarean Section - statistics & numerical data; Childbirth; Childbirth & labor; Childrens health; Concentration index; Cross-Sectional Studies; Delivery care; Delivery, Obstetric - statistics & numerical data; Developing countries; Education; Female; Health aspects; Health care; Health facilities; Health services; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - statistics & numerical data; Humans; Income - statistics & numerical data; Inequity; LDCs; Maternal & child health; Maternal Health Services - statistics & numerical data; Maternal mortality; Medical care; Myanmar; Population; Pregnancy; Pregnant women; Prenatal care; Prenatal Care - statistics & numerical data; Rural areas; Rural health care; Sample size; Socioeconomic Factors; Socioeconomics; Teenage parents; Teenagers; Universal Health Insurance - statistics & numerical data; Urban areas; Utilization; Wealth index; Womens health; Young Adult
• ISSN: 1475-9276; 1475-9276
• DOI: 10.1186/s12939-018-0778-0

Equity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of antenatal and delivery care have been reported in many countries, but have not yet been studied in Myanmar. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar. A community-based cross-sectional survey using multistage sampling was conducted from October to November 2016. A wealth index was selected as the main socioeconomic parameter for measuring inequities with respect to early initiation of antenatal care (ANC), number of antenatal care visits, delivery by a skilled birth attendant (SBA) and delivery by cesarean section (CS). Inequities were evaluated using concentration curves and concentration indexes. Of the 762 women who gave birth within the 12-month survey period, there was no evidence of inequity in utilization of ANC; however, inequity of at least one antenatal visit among women aged less than 20 years was found with a concentration index of 0.04. The concentration indexes for delivery by SBA and CS were 0.05 and 0.14, respectively. Delivery by CS was disproportionately higher in adolescents and women with higher education than middle school. There was no overall inequity in the utilization of ANC but substantial inequities in delivery by CS and SBA were shown. Social determinants of health, particularly age and education, were associated with inequities in the utilization of delivery care. Adolescent pregnant women were found to be particularly vulnerable, and thus should be a target group for strategic plans to reduce inequities in utilization of delivery care.