RT Journal Article
SR Electronic
T1 Reduction in inequality in antenatal-care use and persistence of inequality in skilled birth attendance in the Philippines from 1993 to 2008
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e002507
DO 10.1136/bmjopen-2012-002507
VO 3
IS 6
A1 Honey Faith Molina
A1 Keiko Nakamura
A1 Masashi Kizuki
A1 Kaoruko Seino
YR 2013
UL http://bmjopen.bmj.com/content/3/6/e002507.abstract
AB Objective To assess changes in the inequalities associated with maternal healthcare use according to economic status in the Philippines. Design An analysis of four population-based data sets that were conducted between 1993 and 2008. Setting Philippines. Participants Women aged 15–49 years who had a live-birth within 1 year in 1993 (n=1707), 1998 (n=1513), 2003 (n=1325) and 2008 (n=1209). Outcomes At least four visits of antenatal care, skilled birth attendance and delivery in a medical facility. Results The adjusted OR for antenatal-care use when comparing the highest wealth-index quintile with the lowest quintile declined from 1993 to 2008: 3.43 (95% CI 2.22 to 5.28) to 2.87 (95% CI 1.31 to 6.29). On the other hand, the adjusted OR for the other two outcome indicators by the wealth index widened from 1993 to 2008: 9.92 (95% CI 5.98 to 16.43) to 15.53 (95% CI 6.90 to 34.94) for skilled birth attendance and 7.74 (95% CI 4.22 to 14.21) to 16.00 (95% CI 7.99 to 32.02) for delivery in a medical facility. The concentration indices for maternal health utilisation in 1993 and 2008 were 0.19 and 0.09 for antenatal care; 0.26 and 0.24 for skilled birth attendance and 0.41 and 0.35 for delivery in a medical facility. Conclusions Over a 16-year period, gradients in antenatal-care use decreased and the high level of inequalities in skilled birth attendance and delivery in a medical facility persisted. The results showed a disproportionate use of institutional care at birth among disadvantaged Filipino women.