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other·public health, epidemiology, obstetrics and gynecology, observational study·PMC10585846

Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People’s Democratic Republic from 2006 to 2017: MICS data analysis.

Tropical Medicine and Health · 8 authors, 3 centres

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TL;DR

This study analyzed three national surveys to compare trends in inequalities for maternal health service use in Lao PDR. It found a major decline in residence-based inequality from 2006 to 2011-12, and a major decline in wealth-based inequality from 2011-12 to 2017.

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The study analyzed three repeated cross-sectional Lao Social Indicator Survey datasets (2006, 2011-12, 2017) to assess trends in sociodemographic and economic inequalities in maternal health service use. Inequalities were measured using concentration indices. The central results show that between 2006 and 2011-12, the most significant decline in inequality was based on area of residence for services like antenatal care (CIX change from 0.281 to 0.158). Between 2011-12 and 2017, the largest decrease in inequality was based on wealth quintiles, with the concentration index for institutional delivery changing from 0.337 to 0.193. Limitations include the inability to adjust for confounders and the age of the latest dataset. The findings suggest post-2012 policies may have improved access for poorer groups, but wealth-related inequalities remained the highest in 2017.

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other

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public health

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ORIGINAL PAPER

PMC10585846

Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People’s Democratic Republic from 2006 to 2017: MICS data analysis.

Tropical Medicine and Health

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ABSTRACT

Abstract Background Maternal mortalities remain high in the Lao People ’ s Democratic Republic (Lao PDR) . Since 2012, to improve access to maternal health services for all women, the country implemented several policies and strategies including user fee removal interventions for childbirth-related care. However, it remains unclear whether inequalities in access to services have reduced in the post-2012 period compared to pre-2012. Our study compared the change in sociodemographic and economic inequalities in access to maternal health services between 2006 to 2011–12 and 2011–12 to 2017. Methods We used the three most recent Lao Social Indicator Survey datasets conducted in 2006, 2011–12, and 2017 for this analysis. We assessed wealth, area of residence, ethnicity, educational attainment, and women’s age-related inequalities in the use of at least one antenatal care (ANC) visit with skilled personnel, institutional delivery, and at least one facility-based postnatal care (PNC) visit by mothers. The magnitude of inequalities was measured using concentration curves, concentration indices (CIX), and equiplots. Results The coverage of at least one ANC with skilled personnel increased the most between 2012 and 2017, by 37.1% in Hmong minority ethnic group women, 36.1% in women living in rural areas, 31.1%, and 28.4 in the poorest and poor, respectively. In the same period, institutional deliveries increased the most among women in the middle quintiles by 32.8%, the poor by 29.3%, and Hmong women by 30.2%. The most significant reduction in inequalities was related to area of residence between 2006 and 2012 while it was based on wealth quintiles in the period 2011–12 to 2017. Finally, in 2017, wealth-related inequalities in institutional delivery remained high, with a CIX of 0.193 which was the highest of all CIX values. Conclusion There was a significant decline in inequalities based on the area of residence in the use of maternal health services between 2006 and 2011–12 while between 2011–12 and 2017, the largest decrease was based on wealth quintiles. Policies and strategies implemented since 2011–12 might have been successful in improving access to maternal health services in Lao PDR. Meanwhile, more attention should be given to improving the uptake of facility-based PNC visits. Keywords: Free maternal and child health policy, Antenatal care, Institutional delivery, Postnatal care, Inequality, Lao PDR

CITATION EXPORT

Noudéhouénou Credo Adelphe Ahissou, Daisuke Nonaka, Rie Takeuchi et al.. Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People’s Democratic Republic from 2006 to 2017: MICS data analysis.. Tropical Medicine and Health. (2023). https://doi.org/10.1186/s41182-023-00548-2

AUTHORS

8 · 3 CENTRES

Noudéhouénou Credo Adelphe Ahissou, Daisuke Nonaka, Rie Takeuchi, Calvin de los Reyes, Manami Uehara, Phongluxa Khampheng, Sengchanh Kounnavong, Jun Kobayashi

1Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
2Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
3College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines