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Reduction in inequality in antenatal-care use and persistence of inequality in skilled birth attendance in the Philippines from 1993 to 2008
Open accessAbstract
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.
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The DHS wealth index shows a relative position measured using a composite economic status indicator among the participants of a particular year and country, which prevents the wealth index scores for different years from being compared.
“However, the present study has some potential limitations, and caution is needed in interpreting trends in health and healthcare utilization based on the DHS wealth index, considering that the index shows a relative position measured using a composite economic status indicator among the participants of a particular year and country, which prevents the wealth index scores for different years from”
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Exploring inequalities in access to and use of maternal health services in South Africa
Silal, S. P., Penn-Kekana, L., Harris, B., Birch, S., & McIntyre, D. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-120 · Cited by 211
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Siongco, K. L. L., Nakamura, K., & Seino, K. (2020) · Environmental Health and Preventive Medicine · doi:10.1186/s12199-020-00854-9 · Cited by 17
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Metadata
- Authors
- Molina, H. F., Nakamura, K., Kizuki, M., & Seino, K.
- Affiliations
- Tokyo Medical and Dental University (JP)
- Corresponding author
- Nakamura, Keiko
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2013
- Volume
- 3
- Issue
- 6
- Pages
- e002507
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC3686232
- OpenAlex
- W2146664769
- Cited by
- 21
- References
- 2
- Citations by year
- 2025: 2 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 1
- FWCI
- 1.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Japan Society for the Promotion of Science (24390164)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Keywords
- maternal health inequalities, prenatal care, skilled birth attendance, institutional delivery, wealth index, socioeconomic status, concentration index, Philippines
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