ArticleJournal of global health2018
Examining horizontal inequity and social determinants of inequality in facility delivery services in three South Asian countries.
Article in Journal of global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Inequity in uptake of maternal health care services in developing countries: a systematic review and meta-analysis.Frontiers in public health · 2024Pooled it
- Who gets to deliver in a health facility? An investigation of wealth-based inequities in institutional delivery in Ghana.BMJ open · 2026Article
- Application of the CLEAR toolkit in healthcare settings to address the social determinants of health: a facility-based interventional exploratory study in Khyber Pakhtunkhwa, Pakistan.BMJ public health · 2026Article
- Inequality in Utilization of Maternal Healthcare Services in Low‑ and Middle‑Income Countries: A Scoping Review of the Literature.Maternal and child health journal · 2025Article
- Socio-economic and geographic equity in maternal health services utilization in Ethiopia: a community-based cross-sectional study.BMC health services research · 2025Article
- Barriers and Facilitators to Accessing and Using Maternal Healthcare Services by Women Living in Rural Bangladesh: A Theory-Guided Narrative Literature Review.Public health reviews · 2025Review
- Article
- Prevalence and determinants of socioeconomic inequality in caesarean section deliveries in Bangladesh: an analysis of cross-sectional data from Bangladesh Demographic Health Survey, 2017-18.BMC pregnancy and childbirth · 2023Article
- Comparison of inequality in utilization of postnatal care services between Bangladesh and Pakistan: Evidence from the Demographic and Health Survey 2017-2018.BMC pregnancy and childbirth · 2023Article
- Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017-2018.Reproductive health · 2023Article
- High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal?Reproductive health · 2022Article
- Horizontal inequity in the utilisation of Continuum of Maternal Health care Services (CMHS) in India: an investigation of ten years of National Rural Health Mission (NRHM).International journal for equity in health · 2022Article
- Predictors of wealth-related inequality in institutional delivery: a decomposition analysis using Nepal multiple Indicator cluster survey (MICS) 2019.BMC public health · 2021Article
- Focus on disability-free life expectancy: implications for health-related quality of life.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2021Article
- Intersectional (in) equities in contact coverage of maternal and newborn health services in Nepal: insights from a nationwide cross-sectional household survey.BMC public health · 2021Article
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- Article
- Wealth Inequality as a Predictor of Subjective Health, Happiness and Life Satisfaction among Nepalese Women.International journal of environmental research and public health · 2018Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe utilization of maternal health care services has increased in many developing countries, but persistent wealth-related inequalities in use of maternal services remained an important public health issue. The paper examined the horizontal inequities and identified the key social determinants that can potentially explain such wealth-related inequalities in use of facility delivery services.
methodsThe countries studied are Bangladesh, Pakistan and Nepal. We used horizontal inequity index to measure the horizontal inequity and decomposition of concentration index method to assess the contribution of different social determinants towards the wealth-related inequality. We have used household and women data from demographic and health surveys of Bangladesh (BDHS 2014), Pakistan (PDHS 2012-13) and Nepal (NDHS 2010-11).
resultsAll three countries showed pro-rich inequality in use of facility delivery services (Observed Concentration Index: Bangladesh = 0.235; Pakistan = 0.141; Nepal = 0.263). The study showed if the utilization were solely based on need factors there would have been little disparity between the rich and the poor (Need expected Concentration Index: Bangladesh = 0.004; Pakistan = 0.004; Nepal = 0.008). The use of facility delivery remained pro-rich in all three countries after taking the need factors into account (Horizontal inequity Index: Bangladesh = 0.231; Pakistan = 0.137; Nepal = 0.254). The decomposition analysis revealed that facility delivery is driven mostly by the social determinants of health rather than the individual health risk. Household socioeconomic condition, parental education, place of residence and parity emerged as the most important factors.
conclusionsOur study reiterates the importance of addressing social determinants of health in tackling wealth-related inequalities in use of facility delivery services. Health policy makers should acknowledge the importance of social determinants in determining individual health-seeking behaviour and accordingly set their strategies to improve access to facility delivery.
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