Article Text
Abstract
Objectives (1) To assess the levels of impoverishment and catastrophic expenditure due to out-of-pocket (OOP) payments for antenatal care (ANC) and delivery care in Yangon Region, Myanmar; and (2) to explore the determinants of impoverishment and catastrophic expenditure.
Design, setting and participants A community-based cross-sectional survey among women giving birth within the past 12 months in Yangon, Myanmar, was conducted during October to November 2016 using three-stage cluster sampling procedure.
Outcome measures Poverty headcount ratio, normalised poverty gap and catastrophic expenditure incidence due to OOP payments in the utilisation of ANC and delivery care as well as the determinants of impoverishment and catastrophic expenditure.
Results Of 759 women, OOP payments were made by 75% of the women for ANC and 99.6% for delivery care. The poverty headcount ratios after payments increased to 4.3% among women using the ANC services, to 1.3% among those using delivery care and to 6.1% among those using both ANC and delivery care. The incidences of catastrophic expenditure after payments were found to be 12% for ANC, 9.1% for delivery care and 20.9% for both ANC and delivery care. The determinants of impoverishment and catastrophic expenditure were women’s occupation, number of household members, number of ANC visits and utilisation of skilled health personnel and health facilities. The associations of the outcomes with these variables bear both negative and positive signs.
Conclusions OOP payments for all ANC and delivery care services are a challenge to women, as one of fifteen women become impoverished and a further one-fifth incur catastrophic expenditures after visiting facilities that offer these services.
- impoverishment
- catastrophic expenditure
- out-of-pocket payment
- antenatal care
- delivery care
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Footnotes
Contributors All authors contributed to the concept and design of the study. ANMM and TL participated in data collection, data analysis, interpretation of data and preparation of the draft manuscript. TTH, MMW, JS and EB also assisted with interpretation of data and commented on the draft manuscript. All authors read and approved the final manuscript.
Funding The Norwegian Agency for Development Cooperation (Norad) funded the project ‘Health and Sustainable Development in Myanmar–Competence building in public health and medical research and education, MY-NORTH’, through the NORHED programme: Norad: 1300650, MMR-13/0049 NORHED, UiO: 211782.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Ethical clearances for the study were obtained from the Ethics Review Committee of Prince of Songkla University, Thailand, the Department of Medical Research, Myanmar, and the Norwegian National Research Ethics Committee (NSD), Norway.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available. Original data without identity can be provided on request after the Ethics Review Committee of Prince of Songkla University is informed and provides their approval.