Huge poor–rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries
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OBJECTIVE: Progress towards the Millennium Development Goals for maternal health has been slow, and accelerated progress in scaling up professional delivery care is needed. This paper describes poor-rich inequalities in the use of maternity care and seeks to understand these inequalities through comparisons with other types of health care. METHODS: Demographic and Health Survey (DHS) data from 45 developing countries were used to describe poor-rich inequalities by wealth quintiles in maternity care (professional delivery care and antenatal care), full childhood immunization coverage and medical treatment for diarrhoea and acute respiratory infections (ARI). FINDINGS: Poor-rich inequalities in maternity care in general, and professional delivery care in particular, are much greater than those in immunization coverage or treatment for childhood illnesses. Public-sector inequalities make up a major part of the poor-rich inequalities in professional delivery attendance. Even delivery care provided by nurses and midwives favours the rich in most countries. Although poor-rich inequalities within both rural and urban areas are large, most births without professional delivery care occur among the rural poor. CONCLUSION: Poor-rich inequalities in professional delivery care are much larger than those in the other forms of care. Reducing poor-rich inequalities in professional delivery care is essential to achieving the MDGs for maternal health. The greatest improvements in professional delivery care can be made by increasing coverage among the rural poor. Problems with availability, accessibility and affordability, as well as the nature of the services and demand factors, appear to contribute to the larger poor-rich inequalities in delivery care. A concerted effort of equity-oriented policy and research is needed to address the huge poor-rich inequalities in maternity care.
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Access to early first screening is highly linked to universal and free prenatal care.
“Access to early first screening is highly linked to universal and free prenatal care. 29 , 30”
From Syphilis in pregnancy: A practical guide for prenatal care providers (2025) · cites this paper as [29]
The Maternity care section reports wealth differences in use of antenatal care, and the Affordability section says costs may be less of a barrier to antenatal care than to delivery care. Neither section addresses early first screening or links its timing to universal, free prenatal care (searched for early screening, first visits, and free antenatal care). (LLM, conf=0.75)
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- Authors
- Houweling, T. A., Ronsmans, C., Campbell, O. M., & Kunst, A. E.
- Affiliations
- Erasmus MC (NL)
- London School of Hygiene & Tropical Medicine (GB)
- Venue
- Bulletin of the World Health Organization
- Publisher
- WHO Press
- Published
- 2007-10
- Volume
- 85
- Issue
- 10
- Pages
- 745-754
- ISSN
- 0042-9686 (ISSN-L)
- PMC
- PMC2636501
- OpenAlex
- W2097422804
- Cited by
- 388
- References
- 45
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 16 · 2023: 11 · 2022: 20 · 2021: 22 · 2020: 56 · 2019: 19 · 2018: 23 · 2017: 26 · 2016: 27 · 2015: 35 · 2014: 23 · 2013: 21 · 2012: 17
- FWCI
- 12.45
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Bulletin of the World Health Organization (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- obstetric care, prenatal care, childhood vaccination coverage, diarrhea treatment, acute respiratory infections, urban-rural differences, wealth inequality, maternal health equity, Millennium Development Goals, developing countries, public sector health care, nurses and midwives
- MeSH terms
- Child, Child Health Services, Developing Countries, Diarrhea, Female, Health Workforce, Health Services Accessibility, Humans, Maternal Health Services, Pregnancy, Quality of Health Care, Respiratory Tract Infections, Vaccination, Private Sector, Public Sector, Parturition
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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