Background: Few studies have assessed whether the poorest people in
developing countries benefit from giving birth at home rather than in a
facility. We analysed whether socioeconomic status results in
differences in the use of professional midwives at home and in a basic
obstetric facility in a rural area of Bangladesh, where obstetric care
was free of charge.
Methods: We routinely obtained data from Matlab, Bangladesh between 1987
and 2001. We compared the benefits of home-based and facility-based
obstetric care using a multinomial logistic and binomial log link
regression, controlling for multiple confounders.
Findings: Whether or not a midwife was used at home or in a facility
differed significantly with wealth (adjusted odds ratio comparing the
wealthiest and poorest quintiles 1·94 [95% CI 1·69-2·24] for
home-based care, and 2·05 [1·72-2·43] for facility-based care). The
gap between rich and poor widened after the introduction of
facility-based care in 1996. The risk ratio (RR) between the wealthiest
and poorest quintiles was 1·91 (adjusted RR 1·49 [95% CI 1·16-1·91]
when most births with a midwife took place at home compared with 2·71
(1·66 [1·41-1·96]) at the peak of facility-based care).
Interpretation: In this area of Bangladesh, a shift from home-based to
facility-based basic obstetric care is feasible but might lead to
increased inequities in access to health care. However, there is also
evidence of substantial inequities in home births. Before developing
countries reinforce home-based births with a skilled attendant, research
is needed to compare the feasibility, cost, effectiveness,
acceptability, and implications for health-care equity in both
Chowdhury, M.E.; Ronsmans, C.; Killewo, J.; Anwar, I.; Gausia, K.; Das-Gupta, S.; Blum, L.S.; Dieltiens, G.; Marshall, T.; Saha, S.; Borghi, J. Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study. Lancet (2006) 367 (9507) 327-332. [DOI: 10.1016/S0140-6736(06)68070-7]
Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study.