Inequities in utilization of maternal health interventions in Namibia: implications for progress towards MDG 5 targets

International Journal for Equity in Health

Research

Eyob Zere¹  Oladapo Walker¹  Prosper Tumusiime¹  Thomas Mbeeli²  Joses Kirigia³  Chris Mwikisa³ 

[1] Inter-country Support Team for Eastern and Southern Africa, World Health Organization, Regional Office for Africa, Harare, Zimbabwe;Ministry of Health and Social Services, Windhoek, Namibia;World Health Organization, Regional Office for Africa, Brazzaville, Congo;

关键词: Antenatal Care;    Maternal Health;    Human Development Index;    Concentration Index;    Socioeconomic Inequality;   

DOI  :  10.1186/1475-9276-9-16

 received in 2010-03-17, accepted in 2010-06-12,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundInequities in the utilization of maternal health services impede progress towards the MDG 5 target of reducing the maternal mortality ratio by three quarters, between 1990 and 2015. In Namibia, despite increasing investments in the health sector, the maternal mortality ratio has increased from 271 per 100,000 live births in the period 1991-2000 to 449 per 100,000 live births in 1998-2007. Monitoring equity in the use of maternal health services is important to target scarce resources to those with more need and expedite the progress towards the MDG 5 target. The objective of this study is to measure socio-economic inequalities in access to maternal health services and propose recommendations relevant for policy and planning.MethodsData from the Namibia Demographic and Health Survey 2006-07 are analyzed for inequities in the utilization of maternal health. In measuring the inequities, rate-ratios, concentration curves and concentration indices are used.ResultsRegions with relatively high human development index have the highest rates of delivery by skilled health service providers. The rate of caesarean section in women with post secondary education is about seven times that of women with no education. Women in urban areas are delivered by skilled providers 30% more than their rural counterparts. The rich use the public health facilities 30% more than the poor for child delivery.ConclusionMost of the indicators such as delivery by trained health providers, delivery by caesarean section and postnatal care show inequities favoring the most educated, urban areas, regions with high human development indices and the wealthy. In the presence of inequities, it is difficult to achieve a significant reduction in the maternal mortality ratio needed to realize the MDG 5 targets so long as a large segment of society has inadequate access to essential maternal health services and other basic social services. Addressing inequities in access to maternal health services should not only be seen as a health systems issue. The social determinants of health have to be tackled through multi-sectoral approaches in line with the principles of Primary Health Care and the recommendations of the Commission on Social Determinants of Health.

【 授权许可】

CC BY   
© Zere et al; licensee BioMed Central Ltd. 2010