Socioeconomic equity in maternal health services use in Bangladesh: The role of service readiness in health facilities during the period 2001–2016

Abstract

Background Equity in health services use is related to utilizing equal treatment for equal health needs, irrespective of socioeconomic status. Inequity in maternal health services use in low- and middle-income countries has become a central public health policy and research issue in recent years to achieve universal health coverage by 2030. For Bangladesh, we examined if the socioeconomic equity for selected maternal health services use (viz., antenatal care from a medically trained provider, facility delivery, and management of complications) improved more in districts with high facility readiness than in the rest of the country during 2001‒2016. Methods We used data from three rounds of the Bangladesh Maternal Mortality and Health Care Survey and corresponding rounds of the Bangladesh Health Facility Survey to estimate the differential effect of facility readiness on equity in maternal health services use during 2001‒2016. We applied an adaptation of the Difference-in-Differences (DID) model based on linear probability models on a pooled dataset of 2001, 2010, and 2016 household surveys linked to corresponding health facility surveys. Results Bangladesh has made impressive improvements in the overall use of maternal health services, but the increase was not uniform for all the population groups. Though there have been modest improvements in equity for ANC and treatment for complications, inequity for facility delivery increased noticeably between 2001 and 2016. The nonpoor-poor gap in the high facility readiness districts increased faster than in the low readiness districts during 2001‒2016, resulting in a more inequitable distribution of facility delivery services (p < 0.05). We also found that ANC became more equitable between 2001 and 2016 among women living < 1 hour from a private facility (p < 0.05). Conclusions This is the first systematic investigation of the role of facility readiness on maternal health equity in Bangladesh using nationally representative data. This study found persistent socioeconomic inequities in the use of all three key maternal health services, and for facility delivery, socioeconomic inequity worsened over time. The empirical evidence and policy measures presented here provide a way forward for policymakers to provide equitable care for safe delivery services in Bangladesh.