|14. A Global Picture of Poor-rich Differences in the Utilisation of Delivery Care|
The purpose of this paper is to give a global picture of poor-rich differences in the utilisation of delivery care and other maternal health services. Results published in accessible literature are reviewed and complemented with recent data based on the Demographic and Health Survey (DHS) program.
The results of descriptive and comparative studies are summarised in five points:
In most countries, poor-rich differences in the utilisation of delivery care are huge.
Wealth and delivery care use are associated across the entire wealth hierarchy.
Inequalities in delivery care use are much larger in some countries than in others.
Inequalities tend to be smaller in countries with high female literacy rates.
Large inequalities are observed with respect to most maternal health services.
Results that are relevant to the explanation of inequalities are summarised in four points:
A minor part of poor-rich disparities are due to confounders such as rural vs. urban residence.
Lower use of delivery care by poor mothers is partly due to their lower education.
A wide array of factors mediate the effect of income or education on the use of delivery care.
Poor-rich disparities are strongly sensitive to the national and local context.
The final section of the paper discusses implications for maternal health policies.