Equity in antenatal care quality: an analysis of 91 national household surveys

摘要: Summary Background Emerging data show that many low-income and middle-income country (LMIC) health systems struggle to consistently provide good-quality care. Although monitoring of inequalities in access services has been the focus major international efforts, health-care quality have not systematically examined. Methods Using most recent (2007–16) Demographic Health Surveys Multiple Indicator Cluster 91 LMICs, we described antenatal care based on receipt three essential (blood pressure urine blood testing) among women who had at least one visit with a skilled antenatal-care provider. We compared across income groups quantified within-country wealth-related using slope relative indices inequality. summarised random-effects meta-analyses assessed extent which other geographical sociodemographic factors could explain these inequalities. Findings Globally, 72·9% (95% CI 69·1–76·8) used reported testing; this number ranged from 6·3% Burundi 100·0% Belarus. Antenatal lagged behind coverage countries, where 86·6% (83·4–89·7) accessed but only 53·8% (44·3–63·3) receiving services. Receipt was correlated gross domestic product per capita 40 percentage points higher upper-middle-income countries countries. Within wealthiest were average four times more likely report good than poorest (relative index inequality 4·01, 95% 3·90–4·13). Substantial remained after adjustment for subnational region, urban residence, maternal age, education, visits (3·20, 3·11–3·30). Interpretation Many LMICs reached high levels much lower inequitable quality. Achieving ambitious maternal, newborn, child goals will require greater their equitable distribution. Equity effective should be as new metric monitor progress towards universal coverage. Funding Bill & Melinda Gates Foundation.