title: Social inequalities in the utilization of maternal care in Bangladesh: Have they widened or narrowed in recent years?
abstract: BACKGROUND
  Notwithstanding the significant progress in reducing maternal mortality in recent years, social inequalities in the utilization of maternal care continue to be a challenge in Bangladesh. In this study, we aim to provide a comprehensive analysis of trends in social inequalities in utilization of antenatal care (ANC), facility based delivery (FBD), and skilled birth attendance (SBA) in Bangladesh between 1995 and 2010.
  
  
  METHODS
  Data were extracted from the five latest rounds of Bangladesh Demographic Health Surveys (BDHS). The Theil index (T) and between-group variance (BGV) were used to calculate relative and absolute disparities in the utilization of three measures (ANC, FBD, and SBA) of maternal care across six administrative regions. The relative and slope indices of inequality (RII and SII, respectively) were also used to calculate wealth- and education-based inequality in the utilization of maternal care.
  
  
  RESULTS
  The results of the T-index suggest that relative inequality in SBA has declined by 0.2% per year. Nevertheless, the estimated BGV demonstrated that absolute inequalities in all three measures of maternal care have increased across administrative divisions. For all three measures of maternal care, the RII and SII indicated consistent socioeconomic inequalities favouring wealthier and more educated women. The adjusted RII suggested that wealth- and education-related inequalities for ANC declined by 9% and 6%, respectively, per year during the study period. The adjusted SII, however, showed that wealth- and education-related inequalities for FBD increased by 0.6% per year.
  
  
  CONCLUSIONS
  Although socially disadvantaged mothers increased their utilization of care relative to mothers of higher socioeconomic status, the absolute gap in utilization of care between socioeconomic groups has increased over time. Our findings indicate that wealthier and more educated women, as well as those living in urban areas, are the major users of ANC, FBD and SBA in Bangladesh. Thus, priority focus should be given to implementing and evaluating interventions that benefit women who are poorer, less educated and live in rural areas.
authors.affiliation: School of Health Administration, Faculty of Health Professions, Dalhousie University, 5161 George Street, Suite 700, Halifax, NS, B3H 4R2, Canada. m.hajizadeh@dal.ca.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hajizadeh
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada. nazmul.alam@umontreal.ca.
authors.forename: Nazmul
authors.initials: N
authors.lastname: Alam
authors.affiliation: Institute for Health and Social Policy & Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada. arijit.nandi@mcgill.ca.
authors.forename: Arijit
authors.initials: A
authors.lastname: Nandi
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008880:Midwifery / Q000706:statistics & numerical data; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data