title: Evaluation of socio-economic inequalities in the use of maternal health services in rural western China.
abstract: OBJECTIVE
  To describe the use of maternal health services according to the standards of the Chinese Ministry of Health, and assess socio-economic inequalities in usage in rural Shaanxi province, western China.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Principal components analysis was used to measure the economic status of households. A concentration index (CI) approach was used as a measure of socio-economic inequalities in the use of maternal health services, and a decomposable CI was used to identify the factors that contributed to the socio-economic inequalities in usage.
  
  
  RESULTS
  In total, 4760 women who had given birth in the preceding three years were selected at random to be interviewed in the five counties. Household wealth index was calculated by constructing a linear index from asset ownership indicators using principal components analysis to derive weights. The CI approach is a standard measure in the analysis of inequalities in health. If the CI for the use of maternal health services is positive, it is pro-rich; if it is negative, it is pro-poor. The decomposition method was used to estimate the contributions of individual factors to CI. The overall CI for five or more prenatal visits was 0.075. The household wealth index was found to make the greatest contribution to socio-economic inequalities for five or more prenatal visits (35.5%), followed by maternal education (28.8%), receipt of a health handbook during pregnancy (12.1%), age group (11.0%), distance from health facility (10.5%), family members (1.5%) and district of residence (0.6%).
  
  
  CONCLUSIONS
  Socio-economic inequalities in the use of prenatal health services were pro-rich in rural western China. Socio-economic inequalities in hospital delivery and postnatal health check-ups were not evident. Improving household economic status, providing prenatal health services for women with low income and low educational level, providing health handbooks and improving traffic conditions should be promoted as methods to eliminate socio-economic inequalities in the use of maternal health services.
authors.affiliation: Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Centre, Xi'an, PR China.
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Centre, Xi'an, PR China.
authors.forename: L
authors.initials: L
authors.lastname: Zeng
authors.affiliation: School of Public Health, University of Sydney, NSW, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Dibley
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine Pembroke Place, Liverpool, UK.
authors.forename: D
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Centre, Xi'an, PR China.
authors.forename: L
authors.initials: L
authors.lastname: Pei
authors.affiliation: Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Centre, Xi'an, PR China. Electronic address: xjtu_yh.paper@aliyun.com.
authors.forename: H
authors.initials: H
authors.lastname: Yan
mesh_terms: D000328:Adult; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Concentration index; Maternal health use; Rural western China; Socio-economic inequalities in the use of maternal health services