Socioeconomic inequalities and determinants of maternal health services in Shaanxi Province, Western China

Prenatal health care interventions are effective ways to improve maternal and neonatal health. There have been few large investigations conducted on the inequalities in maternal health services utilization in Shaanxi Province of west China since the health care reform in 2009. This study examined the inequalities and determinants of maternal health services utilization in Shaanxi Province. A household survey was conducted from August to November in 2013. By using a multistage sampling method, local women aged 15–49 who had given birth in the preceding three years were recruited. Information including social-demographic characteristics and maternal health services utilization was collected through a face-to-face interview. A concentration index approach was used to measure inequalities in maternal health services utilization. A logistic regression model was employed to investigate the determinants of maternal health services utilization. There were 8,488 women from urban areas and 18,724 women from rural areas enrolled in this study. The concentration index for all the indicators of maternal health services utilization showed significance in these two areas. In urban areas, the concentration index of having 5 or more prenatal visits, receiving the first prenatal visit within 12 weeks, delivering at secondary- or higher-level health facilities and delivering by C-section were 0.0356, 0.0166, 0.0177 and 0.0591, respectively, while in rural areas, the corresponding figures were 0.0385, 0.0183, 0.0334 and 0.0566, respectively. The determinants related to maternal health services utilization were women’s age at delivery, educational level, employment status, parity, health problems during pregnancy and household income. Inequalities in maternal health services utilization still exist in Shaanxi Province. Providing maternal health services for younger, less educated, unemployed, high parity and poorer women, especially in rural areas, is expected to reduce the inequalities in maternal health services utilization.