scholarly journals Socioeconomic inequalities in access and use of skilled birth attendants during childbirth in Ghana: a decomposition analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aseye Kpodotsi ◽  
Elizabeth Aku Baku ◽  
Jo Hunter Adams ◽  
Olufunke Alaba
Keyword(s):  
Decomposition Analysis ◽  
Wealth Index ◽  
Skilled Birth Attendance ◽  
Household Wealth ◽  
Socioeconomic Inequalities ◽  
Skilled Birth Attendants ◽  
Contributing Factors ◽  
Maternal Deaths ◽  
Birth Attendants ◽  
Birth Attendance

Abstract Background Equitable access to skilled birth attendance during delivery is vital for reducing global maternal deaths to 70 deaths per 100, 000 to achieve the Sustainable Development Goals (SDGs) by 2030. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequalities in access to skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assesses the socioeconomic inequalities in access and use of skilled birth attendants during delivery in Ghana. Methods Research was conducted through literature reviews and document reviews, and a secondary data analysis of the 2014 Ghana Demographic and Health Survey (GDHS), a nationally representative survey. A total of 1305 women aged 15–49 years, who had a live birth the year before to the survey in the presence of a skilled birth attendant were analysed using concentration indices and curves. The indices were further decomposed to identify the major socioeconomic factors contributing most to the inequalities. Results The results found that access to skilled birth attendants was more among women from rich households showing a pro-rich utilization. The decomposition analysis revealed that household wealth index, educational level of both mother and husband/partner, area of residence and mother’s health insurance coverage were the major contributing factors to socioeconomic inequalities in accessing skilled birth attendants during child delivery among Ghanaian women. Conclusion This study confirms that a mother’s socioeconomic status is vital to reducing maternal deaths. Therefore, it is worthy to focus attention on policy interventions to reduce the observed inequalities as revealed in the study.

scholarly journals Socioeconomic Inequalities in Access to Skilled Birth Attendants During Childbirth in Ghana: A Decomposition Analysis

2020 ◽  
Author(s):  
Aseye Kpodotsi ◽  
Elizabeth Aku Baku ◽  
Jo Hunter Adam ◽  
Olufunke Alaba
Keyword(s):  
Concentration Index ◽  
Decomposition Analysis ◽  
Skilled Birth Attendance ◽  
Socioeconomic Inequalities ◽  
Skilled Birth Attendants ◽  
The Sustainable Development ◽  
Birth Attendants ◽  
Policy Interventions ◽  
Birth Attendance ◽  
Development Goals

Abstract Background: Equitable access to, and use of skilled birth attendance during delivery is vital for the achievement of the Sustainable Development Goals (SDGs) in reducing global maternal deaths to 70 deaths per 100, 000. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequities in the use of skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assessed the socioeconomic inequalities related to the use of skilled birth attendants during delivery in Ghana.Methods: This study analyzed data from the 2014 Ghana Demographic and Health Survey (GDHS). Concentration index (CI) and concentration curves (CC) were employed to measure the magnitude of socioeconomic inequality in the use of skilled birth attendants during child delivery. The concentration index was decomposed to identify the underlying factors driving the inequalities.Results: Out of a total of the 1,305 women who gave birth in the year prior to the interview, 28% of the deliveries had no skilled birth attendants of which 60% lives in rural compared to 40% in urban. A concentration index of 0.147 showed a pro-rich utilization of skilled birth attendance during delivery. The decomposition analysis revealed that wealth, education and location of residence were the major contributors to socioeconomic inequalities in the use of skilled birth attendants during child delivery among Ghanaian women.Conclusion: This study suggests that factors such as wealth, area of residence and education are worthy of increased attention and policy interventions because they are amenable to the reduction of observed inequality.

scholarly journals The Prevalence of Skilled Birth Attendant Utilization and Its Correlates in North West Ethiopia

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Mulunesh Alemayehu ◽  
Wubegzier Mekonnen
Keyword(s):  
Skilled Birth Attendant ◽  
Skilled Birth Attendance ◽  
Northwest Ethiopia ◽  
Health Facilities ◽  
Health Centers ◽  
Skilled Birth Attendants ◽  
Urban Residence ◽  
North West ◽  
Birth Attendants ◽  
Birth Attendance

The low utilization of skilled birth attendants sustained high maternal mortality. The aim of this study was to assess its magnitude and correlates in Northwest Ethiopia. A study was conducted on 373 randomly selected women who gave birth in the 12 months preceding the survey. Correlates were identified using binary logistic regression. Skilled birth attendance was 18.8%. Inability to perform cultural practices in health facilities (65.5%), expecting smooth delivery (63.4%), and far distance (62%) were the main barriers. Women with urban residence (AOR = 5.46: 95% CI[2.21–13.49]), primary (AOR = 2.10: 95% CI[0.71–6.16]) and secondary-plus (AOR = 6.12:[1.39–26.92]) educational level, four-plus ANC visits (AOR = 17.33: 95% CI[4.22–71.29]), and proximity to health centers (AOR = 5.67: 95% CI[1.47–25.67]) had higher odds of using skilled birth attendants though women with no labor complications had lower odds (AOR = 0.02: 95% CI[0.01–0.05]). Skilled birth attendance use was low. Urban residence, primary-plus level of education, frequent ANC visits, living nearby the health centers, and a problem during labor were positively correlated with skilled birth attendance utilization. Stakeholders should enhance girls’ education beyond primary level and ANC services and shorten distances to health facilities.

scholarly journals Determinants of skilled birth attendants for delivery in Nepal

2012 ◽  
Vol 8 (3) ◽  
pp. 325-332 ◽  
Author(s):  
Y R Baral ◽  
K Lyons ◽  
J Skinner ◽  
E R Van Teijlingen
Keyword(s):  
Qualitative Research ◽  
Maternal Health ◽  
Health Services ◽  
Quantitative Research ◽  
Skilled Birth Attendance ◽  
Maternal Health Services ◽  
Skilled Birth Attendants ◽  
Birth Attendants ◽  
Birth Attendance ◽  
Women's Role

This review is to explore the factors affecting the uptake of skilled birth attendants for delivery and the issues associated with women’s role and choices of maternal health care service for delivery in Nepal. Literature was reviewed across the globe and discussed in a Nepalese context. Delivery by Skilled Birth Attendance serves as an indicator of progress towards reducing maternal mortality worldwide, the fifth Millennium Development Goal. Nepal has committed to reducing its maternal mortality by 75% by 2015 through ensuring accessibility to the availability and utilisation of skilled care at every birth. The literature suggests that several socio-economic, cultural and religious factors play a significant role in the use of Skilled Birth Attendance for delivery in Nepal. Availability of transportation and distance to the health facility; poor infrastructure and lack of services; availability and accessibility of the services; cost and convenience; staff shortages and attitudes; gender inequality; status of women in society; women’s involvement in decision making; and women’s autonomy and place of residence are significant contributing factors for uptake of Skilled Birth Attendance for delivery in Nepal. The review found more quantitative research studies exploring the determinants of utilisation of the maternal health services during pregnancy in Nepal than qualitative studies. Findings of quantitative research show that different social demographic, economic, socio-cultural and religious factors are responsible for the utilisation of maternal health services but very few studies discussed how and why these factors are responsible for utilisation of skilled birth attendants in pregnancy. It is suggested that there is need for more qualitative research to explore the women’s role and choice regarding use of skilled birth attendants services and to find out how and why these factors are responsible for utilisation of skilled birth attendants for delivery. Qualitative research will help further exploration of the issues and contribute to improvement of maternal health services.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6223 Kathmandu Univ Med J 2010;8(3):325-32 

scholarly journals Exploring socioeconomic inequalities in the use of medicinal herbs among Iranian households: evidence from a national cross-sectional survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Satar Rezaei ◽  
Sina Ahmadi ◽  
Amjad Mohamadi-Bolbanabad ◽  
Ahmad Khanijahani
Keyword(s):  
Socioeconomic Status ◽  
Economic Status ◽  
Household Head ◽  
Decomposition Analysis ◽  
Wealth Index ◽  
Socioeconomic Inequalities ◽  
Medicinal Herbs ◽  
Contributing Factors ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Background Association between socioeconomic status and medicinal herbs (MH) are rarely documented in Iran. Our goal was to measure and decompose socioeconomic inequalities in MH use among Iranian households. Methods The data used in this cross-sectional study were extracted from the 2018 Household Income and Expenditure Survey (HIES) (N = 38,859). Data on MH use, age, gender, and education status of the head of household; a constructed wealth index of household (as a proxy for household’s socioeconomic status); and place of residence (urban or rural) were obtained from the survey. Publicly available province-level data on Human Development Index (HDI) were obtained from the Institute for Management Research at Radbound University. We used the concentration curve and the normalized concentration index (Cn) to measure the magnitude of socioeconomic inequalities in MH among Iranian households. The Cn was decomposed to identify the main determinants of socioeconomic inequalities in MH in Iran. Results The overall prevalence of MH use among Iranian households was 4.7% (95% confidence interval [CI]: 4.5 to 4.9%) in the last month before data collection. The Cn for MH use for the whole of samples was 0.1519; 95% CI = 0.1254 to 0.1784; suggesting a higher concentration of MH use among the households with high socioeconomic level. The decomposition analysis indicated that the main contributing factors to the concentration of MH use were the economic status of households, development status of the province, and education level of the household head. Conclusions This study demonstrated that MH use is more concentrated among socioeconomically advantaged households in Iran and its provinces. This finding might contrast with the widespread belief that wealthy and socioeconomically advantaged populations, compared to low SES groups, tend to seek disproportionately more modern medical treatments and medications than MH. Understanding the factors affecting MH use, socioeconomic inequality in use of MH and its determinants provide an opportunity for health policymakers to design effective evidence-based interventions among providers and consumers of MH.

Multilevel Factors Associated With Pregnancy-Related Health Behaviors in Indonesia: Evidence From the 2007, 2012, and 2017 Indonesian Demographic Health Surveys

2020 ◽  
Vol 32 (2-3) ◽  
pp. 81-90 ◽  
Author(s):  
Muhammad Hardhantyo ◽  
Ying-Chih Chuang
Keyword(s):  
Health Behaviors ◽  
Geographic Location ◽  
Wealth Index ◽  
Nationwide Survey ◽  
Skilled Birth Attendance ◽  
Household Wealth ◽  
Health Condition ◽  
Community Level ◽  
Pregnancy Intentions ◽  
Birth Attendance

This study attempted to examine individual- and community-level factors that contribute to pregnancy-related health behaviors among Indonesian women. This study used representative nationwide survey samples from the Indonesian Demographic Health Survey in the years 2007 (N = 15 193), 2012 (N = 14 431), and 2017 (N = 14 797). Generalized linear mixed models were constructed in the multivariate analyses. We found that women’s educational level, household wealth index, insurance status, access to health facilities, geographic location, general health condition, and pregnancy intentions were significantly associated with different outcome behaviors. Regarding community-level influences, women who lived in communities with a high proportion of educated women and high household wealth were more likely to have skilled birth attendance during childbirth compared with their counterparts in 2007. The similar pattern of results was also found in 2012 and 2017. The findings of this study suggest that future policies should focus on both individual- and community-level factors to improve women’s pregnancy-related behaviors.

scholarly journals Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Alem Desta Wuneh ◽  
Araya Abrha Medhanyie ◽  
Afework Mulugeta Bezabih ◽  
Lars Åke Persson ◽  
Joanna Schellenberg ◽  
...  
Keyword(s):  
Maternal Health ◽  
Child Health ◽  
Health Services ◽  
Wealth Index ◽  
Skilled Birth Attendance ◽  
Maternal Health Services ◽  
Child Health Services ◽  
Services Utilization ◽  
Birth Attendance ◽  
And Child Health

Abstract Background Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. Health equity became central in the post-2015 Sustainable Development Goals globally and is a priority for Ethiopia. The aim of this study was to assess equity in utilization of a range of maternal and child health services by applying absolute and relative equity indices. Methods Data on maternal and child health utilization emanated from a baseline survey conducted for a large project ‘Optimizing the Health Extension Program from December 2016 to February 2017 in four regions of Ethiopia. The utilization of four or more antenatal care visits; skilled birth attendance; postnatal care within 2 days after childbirth; immunization with BCG, polio 3, pentavalent 3, measles and full immunization of children aged 12–23 months; and vitamin A supplementation for 6–23 months old children were stratified by wealth quintiles. The socioeconomic status of the household was assessed by household assets and measured by constructing a wealth index using principal component analysis. Equity was assessed by applying two absolute inequity indices (Wealth index [quintile 5- quintile 1] and slope index of inequality) and two relative inequity indices (Wealth index [quintile5: quintile1] and concentration index). Results The maternal health services utilization was low and inequitably distributed favoring the better-off women. About 44, 71, and 18% of women from the better-off households had four or more antenatal visits, utilized skilled birth attendance and postnatal care within two days compared to 20, 29, and 8% of women from the poorest households, respectively. Skilled birth attendance was the most inequitably distributed maternal health service. All basic immunizations: BCG, polio 3, pentavalent 3, measles, and full immunization in children aged 12–23 months and vitamin A supplementation were equitably distributed. Conclusion Utilization of maternal health services was low, inequitable, and skewed against women from the poorest households. In contrast, preventive child health services were equitably distributed. Efforts to increase utilization and reinforcement of pro-poor and pro-rural strategies for maternal, newborn and immunization services in Ethiopia should be strengthened.

scholarly journals Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242325
Author(s):  
Mohammad Habibullah Pulok ◽  
Gowokani Chijere Chirwa ◽  
Jacob Novignon ◽  
Toshiaki Aizawa ◽  
Marshall Makate
Keyword(s):  
Health Facility ◽  
Socioeconomic Inequality ◽  
Care Service ◽  
Skilled Birth Attendance ◽  
Household Wealth ◽  
Facility Delivery ◽  
Delivery Care ◽  
Health Facility Delivery ◽  
Care Services ◽  
Birth Attendance

Background Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. Methods This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. Results We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. Conclusion This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

scholarly journals Socioeconomic inequalities in women's access to health care: has Ecuadorian health reform succeeded?

2020 ◽  
Author(s):  
Edy Quizhpe ◽  
Miguel San Sebastian ◽  
Enrique Teran ◽  
Anni-Maria Pulkki-Brännström
Keyword(s):  
Health Care ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Access To Health Care ◽  
Skilled Birth Attendance ◽  
Socioeconomic Inequalities ◽  
Socioeconomic Variables ◽  
Birth Attendance ◽  
Access To Health

Abstract Background: Over the last twelve years, Ecuador has implemented a comprehensive health sector reform to ensure equitable access to health care services according to health needs. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. This study assessed whether the health care reform implemented in the 2007 - 2017 decade contributed to reducing the socioeconomic inequalities in women´s health care access.Methods: This study was based on two waves of the Living Standards Measurement Survey conducted in Ecuador in 2006 and 2014. Data from women of reproductive age (15 to 49 years) was analysed to evaluate health care coverage in three indicators: skilled birth attendance, cervical cancer screening and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time.Results: Access to health care increased in the three studied outcomes during the health sector reform. Significant inequality reductions in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a decrease by education was observed for modern contraceptive use. Conclusions: While most socioeconomic inequalities in skilled birth attendance decreased during the reform, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further work is needed to address the social determinants of these health inequalities.

scholarly journals Women empowerment and skilled birth attendance in sub-Saharan Africa: A multi-country analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254281
Author(s):  
Kwamena Sekyi Dickson ◽  
Kenneth Setorwu Adde ◽  
Edward Kwabena Ameyaw
Keyword(s):  
Urban Areas ◽  
Working Women ◽  
Skilled Birth Attendance ◽  
Sub Saharan Africa ◽  
Wife Beating ◽  
Demographic And Health Surveys ◽  
Women Empowerment ◽  
Maternal Deaths ◽  
Birth Attendance ◽  
Sub Saharan

Introduction In 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women’s functionality and healthcare utilisation including use of SBAs’ services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA. Materials and methods This study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs). Results The overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51–0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88–0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03–2.22), or higher education (OR = 4.40, 95% CI = 3.81–5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29–3.73) had higher likelihood of skilled birth attendance. Conclusion These findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.

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