title: Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?
abstract: Universal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011.
  
  
  
  The data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services.
  
  
  
  The concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004-2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women's and their husbands' education were significantly associated with greater use of maternal health care services. In addition, women's exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services.
  
  
  
  Bangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.
authors.affiliation: Department of Economics, Southeast University, Dhaka, Bangladesh. mohammad.pulok@chere.uts.edu.au.|Centre for Health Economics Research and Evaluation (CHERE), University of Technology, Sydney (UTS), Sydney, Australia. mohammad.pulok@chere.uts.edu.au.
authors.forename: Mohammad Habibullah
authors.identifier: 0000-0002-9168-5732
authors.initials: MH
authors.lastname: Pulok
authors.affiliation: Department of Finance, Rawls College of Business, Texas Tech University, Lubbock, USA.
authors.forename: Md Nasim-Us
authors.initials: MN
authors.lastname: Sabah
authors.affiliation: Department of Sociology, University of Alabama at Birmingham, Birmingham, USA.
authors.forename: Jalal
authors.initials: J
authors.lastname: Uddin
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Enemark
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Antenatal care; Bangladesh; Concentration curve; Concentration index; Delivery care; Inequity; Maternal health