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Urban - rural disparities in antenatal care utilization: a study of two cohorts of pregnant women in Vietnam.
Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University, Vietnam.
Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University (HMU), Hanoi, Vietnam.
Nordic Council of Ministers, Nordic School of Public Health NHV.
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2011 (English)In: BMC health services research, ISSN 1472-6963, Vol. 11, 120- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The use of antenatal care (ANC) varies between countries and in different settings within each country. Most previous studies of ANC in Vietnam have been cross-sectional, and conducted in rural areas before the year 2000. This study aims to compare the pattern and the adequacy of ANC used in rural and urban Vietnam following two cohorts of pregnant women.

METHODS: A comparative study with two cohorts comprising totally 2132 pregnant women were followed in two health and demographic surveillance sites, one rural and one urban in Hanoi province, Vietnam. The women were quarterly interviewed using a structured questionnaire until delivery. The primary information obtained was the number and the content of ANC visits.

RESULTS: Almost all women reported some use of ANC. The average number of visits was much lower in the rural setting (4.4) than in the urban (7.7). In the rural area, 77.2% of women had at least three visits and 69.1% attended ANC during the first trimester. The corresponding percentages for the urban women were 97.2% and 97.2%. Only 20.3% of the rural women compared to 81.1% of the urban women received all core ANC services. As a result, the adequate use of ANC was 5.2 times in the urban than in the rural setting (78.3% compared to 15.2%). Nearly all women received ultrasound examination during pregnancy with a mean value of 6.0 scans per woman in the urban area and 3.5 in the rural. Most rural women used ANC at commune health centres and private clinics while urban women mainly visited public hospitals. Expenditure related to ANC utilization for the urban women was 7.1 times that for the urban women.

CONCLUSION: The women in the rural area attended ANC later, had fewer visits and received much fewer services than urban women. The large disparity in ANC adequacy between the two settings suggests special attention for the ANC programme in rural areas focusing on its content. Revision and enforcement of the national guidelines to improve the behaviour and practice of both users and providers are necessary.

Place, publisher, year, edition, pages
2011. Vol. 11, 120- p.
Keyword [en]
Antenatal care; adequacy; disparities; urban - rural comparison; Vietnam
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3603DOI: 10.1186/1472-6963-11-120PubMedID: 21605446OAI: oai:DiVA.org:norden-3603DiVA: diva2:782116
Available from: 2015-01-20 Created: 2015-01-20 Last updated: 2015-01-22Bibliographically approved
In thesis
1. ANTENATAL AND DELIVERY CARE UTILIZATIONIN URBAN AND RURAL CONTEXTS IN VIETNAM: A study in two health and demographic surveillance sites
Open this publication in new window or tab >>ANTENATAL AND DELIVERY CARE UTILIZATIONIN URBAN AND RURAL CONTEXTS IN VIETNAM: A study in two health and demographic surveillance sites
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background. Pregnant women need adequate antenatal care (ANC) and delivery care fortheir own health and for healthy children. Availability of such care has increased in Vietnam but maternal mortality remains high and variable between population groups.

Aims. The general aim of this thesis is to describe and discuss the use of antenatal and delivery care in relation to demographic and socio-economic status and other factors in two health and demographic surveillance sites (HDSS), one rural and one urban. One specificaim of the thesis is to present experiences of running the urban HDSS.

Methods. Between April 2008 and December 2009, 2,757 pregnant women were identifiedin the sites. Basic information was obtained from 2,515 of these. The use of ANC was followed to delivery for 2,132. Three indicators were used. ANC was considered overall adequate if the women started ANC within the first trimester, used three or more visits and received all the six recommended core services at least once during pregnancy. Delivery care was studied for all the 2,515 women.

Main Findings. Nearly all 2,132 participants used ANC. The mean numbers of visits were 4.4 and 7.7 in the rural and urban areas. Mainly due to less than recommended use of core ANC services, overall ANC adequacy was low in some groups, particularly in the rural area (15.2%). The main risk factors for not having adequate ANC were (i) living in a rural area,(ii) low level of education, (iii) low economic status and (iv) exclusive use of private ANC providers. Rural women accessed ANC mainly at commune health centers and private clinics. Urban women accessed ANC and gave birth at central hospitals and provincial hospitals. Caesarean section (CS) was common among urban women (38.5%). Good socioeconomic condition and male babies were associated with delivery in hospitals and CS births. Almost all women had one or more antenatal ultrasound examination, the mean was about 4.5. Rural women spent 3.0% and 19.0% of the reported annual household income percapita for ANC and delivery care, respectively, compared to 6.1% and 20.6% for urbanwomen. The relative economic burden was heaviest for poor rural women.

Conclusion. The coverage of ANC was high in both contexts but with large variations between population subgroups. The major concerns are that poor women in the rural area received incomplete services according to recommendations and that many women, particularly the well-off, in the urban area appeared to overuse technology, ultrasound scanning, delivery in highlevel health care and CS delivery. National maternal healthcare programs should focus on improving ANC service content in rural areas and controlling technology preference in urban. The pregnant women with relatives and friends as well as ANC providers share the responsibility for a positive development. All parties involved must be targeted to improve knowledge, attitudes and practices.

Place, publisher, year, edition, pages
Göteborg: Nordic School of Public Health NHV Göteborg, Sweden, 2012. 68 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2012:7
Keyword
Antenatal care, delivery care, utilization, adequacy, hospital delivery, caesarean section, health and demographic surveillance site, rural and urban, Vietnam.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3612 (URN)978-91-86739-41-6 (ISBN)
Public defence
2012-09-10, Nordic School of Public Health NHV, Box 12133, 402 42 Göteborg, Sweden, 13:00 (English)
Opponent
Supervisors
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2015-01-22Bibliographically approved

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