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A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt.

Benova L, Campbell OM, Ploubidis GB - BMC Health Serv Res (2015)

Bottom Line: The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery.Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources.Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Lenka.Benova@lshtm.ac.uk.

ABSTRACT

Background: The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care.

Methods: Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private).

Results: While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources.

Conclusions: Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term.

No MeSH data available.


Socio-cultural and economic capital mean scores (95% confidence intervals) within subsamples of women who gave birth in the twelve month period preceding survey.
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Fig4: Socio-cultural and economic capital mean scores (95% confidence intervals) within subsamples of women who gave birth in the twelve month period preceding survey.

Mentions: Figure 4 displays the mean levels of socio-economic capital and economic capital between various sub-samples of women with a birth in the year prior to survey. Panels A and B show that the mean scores among women who received complete maternal care was significantly higher than the mean score of all women in this sample and higher than among women who did not receive any facility-based maternal services. Further, Panel C contrasts the mean scores of three subsamples of women according to ANC health-seeking behaviour outcomes. The mean socio-cultural and economic capital scores among women who received free public ANC were marginally lower than among all users of public ANC (p-values 0.052 and 0.029, respectively). However, non-users of ANC had significantly lower mean socio-cultural (p < 0.001) and economic (p = 0.005) capital scores compared to women who received free public ANC. Panel D shows that the data were consistent with no difference in the mean socio-cultural capital (p = 0.983) and economic capital (p = 0.221) scores between women who received free public delivery care and all women who received public delivery care. However, the mean socio-cultural capital and economic capital scores were significantly lower among women who did not deliver in a facility compared to those who received free public care (p-values 0.002 and <0.001, respectively).Figure 4


A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt.

Benova L, Campbell OM, Ploubidis GB - BMC Health Serv Res (2015)

Socio-cultural and economic capital mean scores (95% confidence intervals) within subsamples of women who gave birth in the twelve month period preceding survey.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307186&req=5

Fig4: Socio-cultural and economic capital mean scores (95% confidence intervals) within subsamples of women who gave birth in the twelve month period preceding survey.
Mentions: Figure 4 displays the mean levels of socio-economic capital and economic capital between various sub-samples of women with a birth in the year prior to survey. Panels A and B show that the mean scores among women who received complete maternal care was significantly higher than the mean score of all women in this sample and higher than among women who did not receive any facility-based maternal services. Further, Panel C contrasts the mean scores of three subsamples of women according to ANC health-seeking behaviour outcomes. The mean socio-cultural and economic capital scores among women who received free public ANC were marginally lower than among all users of public ANC (p-values 0.052 and 0.029, respectively). However, non-users of ANC had significantly lower mean socio-cultural (p < 0.001) and economic (p = 0.005) capital scores compared to women who received free public ANC. Panel D shows that the data were consistent with no difference in the mean socio-cultural capital (p = 0.983) and economic capital (p = 0.221) scores between women who received free public delivery care and all women who received public delivery care. However, the mean socio-cultural capital and economic capital scores were significantly lower among women who did not deliver in a facility compared to those who received free public care (p-values 0.002 and <0.001, respectively).Figure 4

Bottom Line: The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery.Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources.Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Lenka.Benova@lshtm.ac.uk.

ABSTRACT

Background: The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care.

Methods: Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private).

Results: While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources.

Conclusions: Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term.

No MeSH data available.