This study investigates the equityimplications of introducing a facility-based maternity carestrategy in rural Bangladesh. The study took place in Matlabsubdistrict in Chandpur District, where the Centre forPopulation and Health Research (ICDDR,B) had initiated ahome-based maternity care program during 1987. During1996-2001 the home-based strategy was replaced by afacility-based strategy that featured gradual upgrading offour ICDDR,B subcentres to provide basic emergencyobstetrical care (EOC). During the 1997-2001 study period 19percent of births took place in ICDDR,B facilities, 4percent occurred in other facilities (public & private),and 2.6 percent births were attended by ICDDR,B midwives athome. The remaining deliveries took place at home withouttrained attendants. The study examines: 1) the extent towhich poorer women in the community used the EOC servicesintroduced and 2) the factors determining the use of thoseservices. It does so by analyzing monitoring and servicedata from the ICDDR,B's maternity care program. Theprincipal findings are that: (i) Women from poorerhouseholds used ICDDR, B delivery facilities significantlyless than their better-off counterparts: the ratio betweenthe best-off and worst-off 20 percent of the population wasnearly 3:1. (ii) While overall facility utilizationincreased during the study period, the economic disparitiesin use persisted. (iii) Factors other than economic statusassociated with use of maternity care were area ofresidence, number of antenatal visits, birth order, maternaleducation and age, and year of delivery.
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