title: Maternal health care utilization in Viet Nam: increasing ethnic inequity.
abstract: OBJECTIVE
  To investigate changes that took place between 2006 and 2010 in the inequity gap for antenatal care attendance and delivery at health facilities among women in Viet Nam.
  
  
  METHODS
  Demographic, socioeconomic and obstetric data for women aged 15-49 years were extracted from Viet Nam's Multiple Indicator Cluster Survey for 2006 (MICS3) and 2010-2011 (MICS4). Multivariate logistic regression was performed to determine if antenatal care attendance and place of delivery were significantly associated with maternal education, maternal ethnicity (Kinh/Hoa versus other), household wealth and place of residence (urban versus rural). These independent variables correspond to the analytical framework of the Commission on Social Determinants of Health.
  
  
  RESULTS
  Large discrepancies between urban and rural populations were found in both MICS3 and MICS4. Although antenatal care attendance and health facility delivery rates improved substantially between surveys (from 86.3 to 92.1% and from 76.2 to 89.7%, respectively), inequities increased, especially along ethnic lines. The risk of not giving birth in a health facility increased significantly among ethnic minority women living in rural areas. In 2006 this risk was nearly five times higher than among women of Kinh/Hoa (majority) ethnicity (odds ratio, OR: 4.67; 95% confidence interval, CI: 2.94-7.43); in 2010-2011 it had become nearly 20 times higher (OR: 18.8; 95% CI: 8.96-39.2).
  
  
  CONCLUSIONS
  Inequity in maternal health care utilization has increased progressively in Viet Nam, primarily along ethnic lines, and vulnerable groups in the country are at risk of being left behind. Health-care decision-makers should target these groups through affirmative action and culturally sensitive interventions.
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden. mats.malqvist@kbh.uu.se
authors.forename: Mats
authors.initials: M
authors.lastname: Målqvist
authors.forename: Ornella
authors.initials: O
authors.lastname: Lincetto
authors.forename: Nguyen Huy
authors.initials: NH
authors.lastname: Du
authors.forename: Craig
authors.initials: C
authors.lastname: Burgess
authors.forename: Dinh Thi Phuong
authors.initials: DT
authors.lastname: Hoa
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014744:Vietnam; D055815:Young Adult