title: Multiple vulnerabilities and maternal healthcare in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000, 2006, and 2011.
abstract: BACKGROUND
  Knowledge of the aggregate effects of multiple socioeconomic vulnerabilities is important for shedding light on the determinants of growing health inequalities and inequities in maternal healthcare.
  
  
  OBJECTIVE
  This paper describes patterns of inequity in maternal healthcare utilization and analyzes associations between inequity and multiple socioeconomic vulnerabilities among women in Vietnam.
  
  
  METHODS
  This is a repeated cross-sectional study using data from the Vietnam Multiple Indicator Cluster Surveys 2000, 2006, and 2011. Two maternal healthcare indicators were selected: (1) skilled antenatal care and (2) skilled delivery care. Four types of socioeconomic vulnerabilities - low education, ethnic minority, poverty, and rural location - were assessed both as separate explanatory variables and as composite indicators (combinations of three and four vulnerabilities). Pairwise comparisons and adjusted odds ratios were used to assess socioeconomic inequities in maternal healthcare.
  
  
  RESULTS
  In all three surveys, there were increases across the survey years in both the proportions of women who received antenatal care by skilled staff (68.6% in 2000, 90.8% in 2006, and 93.7% in 2011) and the proportions of women who gave birth with assistance from skilled staff (69.9% in 2000, 87.7% in 2006, and 92.9% in 2011). The receipt of antenatal care by skilled staff and birth assistance from skilled health personnel were less common among vulnerable women, especially those with multiple vulnerabilities.
  
  
  CONCLUSIONS
  Even though Vietnam has improved its coverage of maternal healthcare on average, policies should target maternal healthcare utilization among women with multiple socioeconomic vulnerabilities. Both multisectoral social policies and health policies are needed to tackle multiple vulnerabilities more effectively by identifying those who are poor, less educated, live in rural areas, and belong to ethnic minority groups.
authors.affiliation: Hanoi School of Public Health, Hanoi, Vietnam; hvm@hsph.edu.vn.
authors.forename: Hoang
authors.initials: H
authors.lastname: Van Minh
authors.affiliation: JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea; oh328@snu.ac.kr.
authors.forename: Juhwan
authors.initials: J
authors.lastname: Oh
authors.affiliation: Department of Health Education, Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Kim Bao
authors.initials: KB
authors.lastname: Giang
authors.affiliation: Center for Population Health Sciences, Hanoi School of Public Health, Hanoi, Vietnam.
authors.forename: Vu Duy
authors.initials: VD
authors.lastname: Kien
authors.affiliation: JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea.|Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: You-Seon
authors.initials: YS
authors.lastname: Nam
authors.affiliation: JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chul Ou
authors.initials: CO
authors.lastname: Lee
authors.affiliation: Department of International Cooperation, Ministry of Health, Hanoi, Vietnam.
authors.forename: Tran Thi Giang
authors.initials: TT
authors.lastname: Huong
authors.affiliation: Department of Biostatistics and Health Informatics, Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Luu Ngoc
authors.initials: LN
authors.lastname: Hoat
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data* / Q000639:trends; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014744:Vietnam
keywords: healthcare; inequality; inequity; multiple socioeconomic vulnerabilities; skilled antenatal care; skilled delivery