Reduction in inequality in antenatal-care use and persistence of inequality in skilled birth attendance in the Philippines from 1993 to 2008.

Abstract

To assess changes in the inequalities associated with maternal healthcare use according to economic status in the Philippines. An analysis of four population-based data sets that were conducted between 1993 and 2008. Philippines. Women aged 15-49 years who had a live-birth within 1 year in 1993 (n=1707), 1998 (n=1513), 2003 (n=1325) and 2008 (n=1209). At least four visits of antenatal care, skilled birth attendance and delivery in a medical facility. The adjusted OR for antenatal-care use when comparing the highest wealth-index quintile with the lowest quintile declined from 1993 to 2008: 3.43 (95% CI 2.22 to 5.28) to 2.87 (95% CI 1.31 to 6.29). On the other hand, the adjusted OR for the other two outcome indicators by the wealth index widened from 1993 to 2008: 9.92 (95% CI 5.98 to 16.43) to 15.53 (95% CI 6.90 to 34.94) for skilled birth attendance and 7.74 (95% CI 4.22 to 14.21) to 16.00 (95% CI 7.99 to 32.02) for delivery in a medical facility. The concentration indices for maternal health utilisation in 1993 and 2008 were 0.19 and 0.09 for antenatal care; 0.26 and 0.24 for skilled birth attendance and 0.41 and 0.35 for delivery in a medical facility. Over a 16-year period, gradients in antenatal-care use decreased and the high level of inequalities in skilled birth attendance and delivery in a medical facility persisted. The results showed a disproportionate use of institutional care at birth among disadvantaged Filipino women.