Background
Equity of access to maternal health interventions in Brazil and Colombia
Methods
Data sources and definition of healthcare intervention variables
Indicator name | Indicator description | Numerator | Denominator |
---|---|---|---|
ANC: Antenatal care (4 or more visits) | Percent of women (counted for each pregnancy) attended at least four times during pregnancy by any provider (skilled or unskilled) for reasons related to the pregnancy in the 5 years prior to the survey | Number of women (counted for each pregnancy) attended at least four times during pregnancy by any provider (skilled or unskilled) for reasons related to the pregnancy in the 5 years prior to the survey | Total number of women (counted for each pregnancy) between 15 and 49 years who had a live birth in the 5 years prior to the survey |
SBA: Skilled birth assistance | Percentage of live births attended by skilled health personnel (only doctor and nurse are considered skilled attendants as there is no proffesional midwifery in Brazil and Colombia) | Number of live births in the 5 years prior to the survey attended during delivery by skilled attendants (doctor or nurse) | Total number of live births to women aged 15–49 years in the 5 years prior to the survey |
C-section rate | Percentage of live births delivered by Caesarean section | Number of live births in the 5 years prior to the survey delivered by Caesarean section | Total number of live births to women aged 15–49 years in the 5 years prior to the survey |
PNC: Postnatal care for mothers | Percentage of women (counted for each pregnancy) who had a postnatal care consultation within two months of childbirth | Number of women (counted for each pregnancy) who had a postnatal care consultation within two months of childbirth (regardless of place of delivery) in the 5 years prior to the survey | Total number of women aged 15–49 years (counted for each pregnancy) who had a live birth in the 5 years prior to the survey (regardless of place of delivery) |
Measures of inequality (concentration index) and decomposition analysis
Results
Coverage rates of maternal health interventions and the extent of inequality across interventions and countries
Interventions | Brazil | Colombia | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Quintiles | Quintiles | |||||||||||
1 | 2 | 3 | 4 | 5 | Overall mean coverage rate | 1 | 2 | 3 | 4 | 5 | Overall mean coverage rate | |
ANC (4 visits or more) | 87.4% | 94.1% | 81.1% | 96.1% | 98.7% | 91.3% | 85.8% | 92.1% | 93.9% | 95.7% | 98.3% | 92.8% |
SBA | 81.9% | 92.2% | 96.1% | 95.5% | 98.6% | 92.9% | 82.7% | 96.1% | 98.7% | 99.3% | 99.4% | 94.3% |
C-section | 18.7% | 32.2% | 36.4% | 46.2% | 62.1% | 39.1% | 25.4% | 34.1% | 36.4% | 40.6% | 43.9% | 35.0% |
PNC (within 2 days of birth)a | 1.1% | 1.1% | 1.2% | 1.3% | 1.8% | 1.2% | ||||||
PNC (within 2 months after birth) | 11.6% | 21.5% | 31.2% | 39.9% | 58.6% | 32.5% | 18.7% | 24.9% | 27.9% | 33.5% | 35.3% | 26.9% |
Concentration index
Interventions | Brazil | Colombia | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
C | Mean coverage rates (μ) | C normalized = (C/1 - μ) | SE (C) | t (C) | Low | High | C | Mean coverage rates (μ) | C normalized = (C/1 - μ) | SE (C) | t (C) | Low | High | |
ANC (4 visits or more) | 0.022 | 0.91 | 0.506 | 0.013 | 1.70 | -0.004 | 0.048 | 0.024 | 0.93 | 0.329 | 0.008 | 3.13 | 0.008 | 0.039 |
SBA | 0.032 | 0.93 | 0.836 | 0.013 | 2.37 | 0.005 | 0.059 | 0.035 | 0.94 | 0.612 | 0.015 | 2.36 | 0.005 | 0.065 |
C-section | 0.207 | 0.39 | 0.362 | 0.055 | 3.74 | 0.095 | 0.318 | 0.097 | 0.35 | 0.150 | 0.029 | 3.30 | 0.038 | 0.157 |
PNC (within 2 months after birth) | 0.277 | 0.32 | 0.456 | 0.068 | 4.05 | 0.14 | 0.415 | 0.123 | 0.27 | 0.168 | 0.028 | 4.32 | 0.066 | 0.180 |
Decomposition analysis of SBA and PNC in Brazil
SBA | PNC | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Elasticities | Concentration indices | Contributions to C | Contributions to C (%) | P values | Elasticities | Concentration indices | Contributions to C | Contributions to C (%) | P values | |
Mother’s age | −0.0082 | 0.0429 | −0.0004 | −1.70% | 0.618 |
0.5588
|
0.0422
|
0.0236
|
8.59%
|
0.006
|
Wanted pregnancy | −0.0004 | 0.0702 | 0.0000 | −0.13% | 0.837 | −0.034 | 0.068 | −0.002 | − 0.86% | 0.295 |
Number of total children born alive |
0.0088
|
−0.0774
|
0.0007
|
3.33%
|
0.020
| −0.1018 | −0.0769 | 0.0078 | 2.85% | 0.114 |
Married or in union | 0.0039 | 0.0396 | 0.0002 | 0.75% | 0.397 | −0.0293 | 0.0387 | −0.0011 | − 0.41% | 0.711 |
Race (white, non-white) | −0.0004 | 0.1924 | −0.0001 | −0.39% | 0.769 | 0.0036 | 0.1912 | 0.0007 | 0.25% | 0.876 |
Mother’s years of schooling | 0.0051 | 0.1333 | 0.0007 | 3.30% | 0.356 |
0.2170
|
0.1327
|
0.0288
|
10.49%
|
0.014
|
Wealth index |
0.0193
|
0.2479
|
0.0048
|
23.44%
|
0.003
|
0.4136
|
0.2473
|
0.1023
|
37.29%
|
0.000
|
Private health insurance plan | −0.0017 | 0.4892 | −0.0008 | −4.13% | 0.341 |
0.0797
|
0.4817
|
0.0384
|
14.00%
|
0.000
|
Benficiary of cash-transfer program ‘bolsa familia’ |
0.0026
|
−0.3469
|
−0.0009
|
−4.44%
|
0.004
| −0.0140 | − 0.3432 | 0.0048 | 1.76% | 0.467 |
Delivery in private hospital |
0.0060
|
0.5611
|
0.0034
|
16.40%
|
0.000
| |||||
Delivery by a doctor |
0.2118
|
0.0623
|
0.0132
|
4.81%
|
0.035
| |||||
Region |
0.0096
|
0.2345
|
0.0023
|
11.06%
|
0.001
|
0.1730
|
0.2344
|
0.0405
|
14.78%
|
0.000
|
Living in urban area (1 = urban, 0 = rural) |
0.0069
|
0.0875
|
0.0006
|
2.95%
|
0.043
|
0.1423
|
0.0883
|
0.0126
|
4.58%
|
0.013
|
Concentration Index w/micro data | 0.0103 | 0.2692 | ||||||||
0.0204 | 50.4% | 0.2743 | 98.12% | |||||||
Total Contribution | 50.44% | 98.12% | ||||||||
Total Contribution (only statistically significant values |
52.74%
|
94.53%
|