title: Family planning, antenatal and delivery care: cross-sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low- and middle-income countries.
abstract: OBJECTIVE
  The objective of this study was to assess the role of the private sector in low- and middle-income countries (LMICs). We used Demographic and Health Surveys for 57 countries (2000-2013) to evaluate the private sector's share in providing three reproductive and maternal/newborn health services (family planning, antenatal and delivery care), in total and by socio-economic position.
  
  
  METHODS
  We used data from 865 547 women aged 15-49, representing a total of 3 billion people. We defined 'met and unmet need for services' and 'use of appropriate service types' clearly and developed explicit classifications of source and sector of provision.
  
  
  RESULTS
  Across the four regions (sub-Saharan Africa, Middle East/Europe, Asia and Latin America), unmet need ranged from 28% to 61% for family planning, 8% to 22% for ANC and 21% to 51% for delivery care. The private-sector share among users of family planning services was 37-39% across regions (overall mean: 37%; median across countries: 41%). The private-sector market share among users of ANC was 13-61% across regions (overall mean: 44%; median across countries: 15%). The private-sector share among appropriate deliveries was 9-56% across regions (overall mean: 40%; median across countries: 14%). For all three healthcare services, women in the richest wealth quintile used private services more than the poorest. Wealth gaps in met need for services were smallest for family planning and largest for delivery care.
  
  
  CONCLUSIONS
  The private sector serves substantial numbers of women in LMICs, particularly the richest. To achieve universal health coverage, including adequate quality care, it is imperative to understand this sector, starting with improved data collection on healthcare provision.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Oona M R
authors.initials: OM
authors.lastname: Campbell
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Lenka
authors.initials: L
authors.lastname: Benova
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: MacLeod
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Baggaley
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rodrigues
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Kara
authors.initials: K
authors.lastname: Hanson
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Powell-Jackson
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Loveday
authors.initials: L
authors.lastname: Penn-Kekana
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Reen
authors.initials: R
authors.lastname: Polonsky
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Katharine
authors.initials: K
authors.lastname: Footman
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Shreya K
authors.initials: SK
authors.lastname: Pereira
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Andreia Costa
authors.initials: AC
authors.lastname: Santos
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Veronique G A
authors.initials: VG
authors.lastname: Filippi
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Lynch
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Goodman
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D003906:Developing Countries; D005193:Family Planning Services; D005260:Female; D014943:Global Health; D000069576:Health Equity; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services; D008875:Middle Aged; D011247:Pregnancy; D011295:Prenatal Care; D017149:Private Sector; D017150:Public Sector; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Demographic and Health Surveys; antenatal care; atención del parto; censos demográficos y sanitarios; cuidados prenatales; delivery care; family planning; maternal heath; planificación familiar; planification familiale; private sector; salud materna; santé maternelle; secteur privé; sector privado; soins prénatals; soins à l'accouchement; surveillances démographiques et de santé