Cited by 388Global Maternal and Child HealthHealthcare Systems and ReformsPublic Health and Social Inequalities

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Huge poor–rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries

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Houweling, Tanja AJ, Ronsmans, Carine, Campbell, Oona MR, Kunst, Anton E·2007·Bulletin of the World Health Organization

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Abstract

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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Authors: Houweling, T. A., Ronsmans, C., Campbell, O. M., & Kunst, A. E.
Affiliations: Erasmus MC (NL)
London School of Hygiene & Tropical Medicine (GB)
ORCID: Houweling, Tanja AJ
Campbell, Oona MR
Kunst, Anton E
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)
DOI: 10.2471/blt.06.038588
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
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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

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Huge poor–rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries

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