Inequality in the Utilization of Maternal Care and the Impact of a Macroeconomic Policy: Evidence from Bangladesh

In this paper we focus on the inequalities in utilization of maternal care and the associations between a macroeconomic policy and the use of maternal health care services in Bangladesh. We use four waves of a repeated cross-section dataset: the Bangladesh Demographic and Health Survey 1997, 2000, 2004 and 2007. We specify the utilization of maternal health care services as a set of three binary variables representing utilization of antenatal care, skilled attendance at birth and giving birth in a health facility. Although the use of maternal care services increased over time, less than one-quarter of mothers used a skilled attendant or gave birth in a health facility in the most recent period. We find that the circumstance factors of respondents, for example, their religion, location, education and household asset had significant associations with their choice of utilization. We observe that horizontal inequity in utilization decreased over time; yet, inequalities in the utilization of maternal care remained large in the most recent period. In addition to these issues, we assess the impacts of the Rights-Based Comprehensive Maternal Care Policy which was implemented in 2001, in response to the Millennium Development Goals in the health sector. We measure the impacts of the policy using the simple difference-in-differences method and inequality indices based difference-in-weighted-differences method. Both approaches find that the policy was effective in promoting utilization of maternal health care services in rural Bangladesh. We find that, in a developing country like Bangladesh, a well-designed health policy that is focused on key circumstance factors of the target group that they cannot control for can increase the use of health care greatly.