Measuring and explaining changing patterns of inequality in institutional deliveries between urban and rural women in Ghana: a decomposition analysis

Background: Maternal health reflects the overall effectiveness of the health system of any country. One strategy for reducing maternal mortality and morbidity is ensuring that every baby is delivered in an institution. Government of India has launched various health schemes under the umbrella of National Rural Health Mission (NRHM) to promote institutional deliveries. Thus this study was conducted to study the socio-demographic determinants of place of delivery and the reasons for preference of place of delivery by rural women.Methods: A community based cross-sectional study was conducted in the field practice area of rural health training center (RHTC), Paithan, Dist. Aurangabad during the period of 1st October 2015 to 31st March 2016. All the villages under two sub-centers of one PHC under the RHTC were selected for the study. All women above 18 years of age who delivered at least once between 1st January 2001 to 31st December 2015, were interviewed for their place of delivery and their socio-demographic profile.Results: It was observed that 564 (80.46%) women were delivered in a hospital, of which 313 (44.65%) and 251 (35.81) were delivered in private and government institutions respectively, while 137 (19.54%) respondent women were delivered at home. Education of women, occupation of women, type of Family, education of husband, occupation of husband, parity, distance of hospital from the residence and women’s age at marriage were the socio-demographic factors found to be significantly associated with place of delivery by the bivariate analysis. Reasons observed for home delivery were related to lack of knowledge about government healthcare facilities, about need for institutional delivery and inability to reach hospital on time.Conclusions: The proportion of home deliveries in 2001-15 was 13.08% as against 35.80% of government institutional deliveries and 44.65% of private institutional deliveries. Education of women, education and occupation of husband were found to be significantly associated with place of delivery by multivariate analysis.

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Purdah and Changing Patterns of Social Control among Rural Women in Bangladesh

Journal of Marriage and Family ◽

10.2307/351808 ◽

1983 ◽

Vol 45 (4) ◽

pp. 949 ◽

Cited By ~ 20

Author(s):

Shelley Feldman ◽

Florence E. McCarthy

Keyword(s):

Social Control ◽

Rural Women ◽

Changing Patterns

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Influences of Proximate Determinates on Fertility Among Urban and Rural Women in Bangladesh

Dhaka University Journal of Science ◽

10.3329/dujs.v66i1.54544 ◽

2018 ◽

Vol 66 (1) ◽

pp. 49-54

Author(s):

Muhammad Mahmudul Hasan ◽

Mirajul Islam ◽

Md Saifullah Sakib ◽

Md Iqramul Haq

Keyword(s):

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Contraceptive Use ◽

Decomposition Analysis ◽

Period Increase ◽

Inhibiting Effect ◽

Interaction Factor ◽

Proximate Determinants ◽

Urban And Rural Areas

Bangladesh has met a lot of challenges in recent decades. The remarkable decline in fertility is one of the major challenges faced by this country. The rate of fertility in rural areas is still higher than urban areas. The proximate determinants of fertility which influence fertility directly are analyzed in this study for urban and rural areas separately as well as the study quantify the decomposition of the differences in total fertility rate (TFR) in residence during 1993-94 to 2014. The effectiveness of contraceptive use is found to be the most important factor for declining fertility. The result revealed that the index of contraception shows a declining trend, indicating an increasingly inhibiting effect on fertility in both urban and rural areas of Bangladesh. The inhibition effect of postpartum infecundability decreases with increase in urbanization. The decomposition analysis shows that fertility decline has been occurred due to delay marriage, increase of contraception practice, shortening of postpartum infecundability period, increase proportion in induced abortion and the interaction factor. Dhaka Univ. J. Sci. 66(1): 49-54, 2018 (January)

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Study of the changing trends in place of delivery in rural women in relation to pre and post NRHM period in Paithan, Aurangabad, Maharashtra

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20172823 ◽

2017 ◽

Vol 4 (7) ◽

pp. 2356 ◽

Cited By ~ 1

Author(s):

Sandeep B. Pund ◽

Bina M. Kuril ◽

Mohan K. Doibale ◽

Rajendra T. Ankushe ◽

Purushottam Kumar ◽

...

Keyword(s):

Rural Health ◽

Rural Women ◽

Cross Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Place Of Delivery ◽

Mortality And Morbidity ◽

Institutional Deliveries ◽

Changing Trends ◽

Increasing Trends

Background: Maternal health reflects the overall effectiveness of the health system of any country. One strategy for reducing maternal mortality and morbidity is ensuring that every baby is delivered in an institution. Government of India has launched various health schemes under the umbrella of National Rural Health Mission (NRHM) to promote institutional deliveries. Thus this study was conducted to study the changing trends in place of delivery in rural women in relation to NRHM.Methods: A community based cross-sectional study was conducted in the field practice area of rural health training center (RHTC), Paithan, Dist. Aurangabad during the period of 1st October 2015 to 31st March 2016. All the villages under two sub-centers of one PHC under the RHTC were selected for the study. All women above 18 years of age who delivered at least once between 1st January 2001 to 31st December 2015, were interviewed for their place of delivery.Results: Institutional deliveries increased from 47.06% to 93.65% in 2001 to 2015. The odds for institutional deliveries in the post NRHM period were seen to vary in the 1st 5 years of NRHM and the next 5 years. In 2006-10, odds of institutional deliveries were 2.44 times more, whereas in 2011-15 the odds were 8.99 times more than the pre-NRHM period. The overall odds of institutional delivery in the post-NRHM period were 4.1 times more than the pre-NRHM period.Conclusions: Increasing trends of institutional deliveries and decreasing trends of home deliveries was observed from 2001 to 2015. Increase in deliveries was seen in both government as well as private hospitals. Institutional deliveries have increased rapidly since the implementation of NRHM with 4.1 times more chance of institutional deliveries in the post-NRHM period.

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Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis

PLoS ONE ◽

10.1371/journal.pone.0255094 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255094

Author(s):

Reta Dewau ◽

Dessie Abebaw Angaw ◽

Getahun Molla Kassa ◽

Baye Dagnew ◽

Yigizie Yeshaw ◽

...

Keyword(s):

Antenatal Care ◽

Rural Women ◽

Access To Health Care ◽

Institutional Delivery ◽

Child Death ◽

Decomposition Analysis ◽

Health Care Facilities ◽

Care Utilization ◽

Oaxaca Decomposition ◽

Urban Rural

Background Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. Methods The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). Results The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. Conclusions The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women’s income, access to health care facilities to increase the frequency of antenatal care utilization.

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Socio-Economic Related Inequalities in The Utilization of Family Planning Services Among Women in Zambia

10.21203/rs.3.rs-63497/v1 ◽

2020 ◽

Author(s):

Simang'aliso Ndhlovu ◽

Maio Bulawayo ◽

Chris Mweemba ◽

Peter Hangoma

Keyword(s):

Family Planning ◽

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Tertiary Education ◽

Decomposition Analysis ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Childbearing Age ◽

Family Planning Services

Abstract Background: While a large literature documents inequalities in healthcare utilization in Zambia, and the rest of sub-Saharan Africa, there has been limited focus on the examination of inequalities in family planning use and in general has increased, health inequalities persist. Similarly, despite the increase in utilization of family planning services from 15% in 1992 to 48% in 2018, the increase has not been equally shared in the population. We examine drivers of socio-economic related inequalities in utilization of family planning services among women of childbearing age in Zambia. Methods: Using secondary data from the 2014 Zambia Demographic and Health Survey (ZDHS), concentration curves and indices are applied to examine how pro-poor and pro-rich the distribution of family planning is. A Blinder-Oaxaca decomposition analysis is conducted to decompose the rural-urban differences in the utilization of family planning services among women of reproductive age. Results: Our findings show that less than half (45%) of the 12,498 respondents used family planning. Use of family planning services was unequally concentrated on the well-off (CI=0.590, P=0.055). The results are mainly driven by inequalities in rural areas (CI=0.4009, P=0.0730) as the distribution of family planning use in urban areas is more equal (CI=0.049, P=0.159). In addition to family planning use being more unequal in rural areas, the proportion of women who use family planning services is 5.16 percentage points lower than in urban areas. The factors accounting for the gap between rural and urban use of family planning, with a tendency to increase it, include wealth (54.79%), tertiary education (79.46%) and age-group of 45-49 years (53.68%). Some factors act to moderate, or reduce this gap and have negative contribution on family planning use. These include women with 7 and more children (-48.22%), being married (-43.45%), primary education (-33.93%) and middle wealth group (-43.75%). Conclusion: Despite progress in the utilisation of family planning services, socioeconomic inequalities have persisted, primarily in rural areas. Interventions to increase family planning use should aim at addressing rural socioeconomic disadvantage, with programs targeting poor women and those with low levels of education. Narrowing the rural-urban gap in family planning use should focus on improving wealth and education of rural women.

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Why women choose to deliver at home in India: a study of prevalence, factors, and socio-economic inequality

BMC Public Health ◽

10.1186/s12889-021-11779-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ratna Patel ◽

Strong P. Marbaniang ◽

Shobhit Srivastava ◽

Pradeep Kumar ◽

Shekhar Chauhan

Keyword(s):

Rural Women ◽

Rural Areas ◽

Contact Point ◽

Decomposition Analysis ◽

Home Delivery ◽

Targeted Interventions ◽

Factors Influencing ◽

Home Deliveries ◽

The Government ◽

At Home

Abstract Background To promote institutional delivery, the Government of India, through the Janani Suraksha Yojana (JSY) program, gives monetary reward to all pregnant women who give birth at the government or private health center. Despite providing cash assistance, a higher number of women are still preferring delivering at home. Therefore, this study sought to determine the prevalence of home births and identifying the factors influencing women’s choice of home deliveries. Methods Data from the National Family Health Survey (NFHS) conducted during 2005–06 and 2015–16 were used in the study. The respondents were women 15–49 years; a sample of 36,850 and 190,898 women in 2005–06 and 2015–16 respectively were included in the study. Multivariate logistic regression was used to determine the factors influencing home delivery. Income-related inequality in home delivery was quantified by the concentration index (CI) and the concentration curve (CC), and decomposition analysis was used to examine the inequality in the prevalence of home deliveries. Results The prevalence of home deliveries has reduced from 58.5% in 2005–06 to 18.9% in 2015–16. The odds of delivering babies at home were lower among women who had full ANC in 2005–06 [AOR: 0.34; CI: 0.28–0.41] and in 2015–16 [AOR: 0.41; CI: 0.38–0.45] and were higher among women with four or higher parity in 2005–06 [AOR: 1.70; CI: 1.49–1.92] and in 2015–19 [AOR: 2.16; CI: 2.03–2.30]. Furthermore, the odds of delivering babies at home were higher among rural women and were lower among women with higher education. It was found that the value of CI increased from − 0.25 to − 0.39 from 2005-06 to 2015–16; this depicts that women delivering babies at home got more concentrated among women from lower socio-economic status. Conclusion There is a need to promote institutional deliveries, particular focus to be given to poor women, women with higher parity, uneducated women, and rural women. ANC is the most concurring contact point for mothers to get relevant information about the risks and complications they may encounter during delivery. Therefore, effort should be directed to provide full ANC. Targeted interventions are called for to bring improvements in rural areas.

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