Date Published: April 24, 2019
Publisher: Public Library of Science
Author(s): Dhammika Deepani Siriwardhana, Arunasalam Pathmeswaran, Ananda Rajitha Wickremasinghe, Mohammad Rifat Haider.
The impact of socioeconomic inequalities on health outcomes and service delivery is increasingly researched globally. This study assessed the overall and sector-wise socioeconomic inequality in postnatal home visits made by Public Health Midwives (PHMs) in Sri Lanka and decomposed the observed socioeconomic inequality into potential determinants.
Data from the Sri Lanka Demographic and Health Survey (SLDHS) 2006–07 were used. Data were collected from ever-married women who gave birth to their last child in 2001 or later (up to 2007). Whether the PHM visited the home to provide postnatal care within one month of the delivery was the health outcome of interest. Sri Lanka is divided into three sectors (areas) as urban, rural, and estate (plantation) based on the geographical location and the availability of infrastructure facilities. Concentration indices were calculated and concentration curves were plotted to quantify the overall and sector-wise socioeconomic inequality. Decomposition analysis using probit regression was performed to estimate the contribution of potential determinants to the observed socioeconomic inequality.
Overall, 83.0% of women were visited by a PHM within one month of the delivery. The highest number of home visits was reported in the rural sector (84.5%) and lowest was reported from the estate sector (72.4%). A pro-poor, pro-rich, and no inequality were observed across urban, rural, and estate sectors respectively. Wealth had a small contribution to the estimated inequality. Province of residence and the education level of women were the main determinants of the observed socioeconomic inequality.
Addressing the socioeconomic inequality of postnatal home visits made by PHMs should not be seen as a health system issue alone. The associated social determinants of health should be addressed through a multi-sectoral approach encompassing the principles of primary health care.
Moving from the Millennium Development Goals, maternal and child health is emphasized in Sustainable Development Goal (SDG) 3 under the global rubric of good health and wellbeing. Two targets related to maternal and child health are included in SDG 3; to reduce the global maternal mortality ratio to less than 70 per 100,000 live births and to end preventable deaths of newborns and children under five years of age. In addition, the SDGs also address the social determinants of health focusing on poverty, education, gender equality and reducing inequalities . Health inequalities exist within and between countries. A health inequality becomes a health inequity when it is unjust and unfair . Therefore, quantifying these inequalities using appropriate measures is a major step in understanding them .
A pro-rich inequality was found in postnatal home visits made by public health midwives in Sri Lanka. The magnitude of the socioeconomic inequality was very small. However, the results varied by the sector of residence (urban, rural, and estate). Province of residence and the education level of women were the main determinants of the observed socioeconomic inequality.