TRUNG TÂM NÂNG CAO SỨC KHOẺ CỘNG ĐỒNG
Inequality: Differences between ethnic minority-related maternal and family health indices and national estimates
Research on “Barriers in accessing maternal health care and family planning services of ethnic minorities in Vietnam” supported by the United Nations Population Fund in collaboration with the Ministry of Health and proposed research scope. The study was conducted by the Research Center of the University of Toronto, Canada and the Mekong Development Research Institute in Hanoi in 2016. The report was developed based on original survey data from about 4,600 ethnic minority women and discussed. focus group (TLN) with more than 100 ethnic minority women and in-depth interviews with health workers, village and village heads. The report includes key indicators of reproductive health (SS), maternal, newborn and child health in relation to access to services and is broken down into four dimensions of wellbeing. inequality (residence, education level, economic status and ethnic group).
This section identifies factors related to the use of maternal health care and family planning services and summarizes the trends and inequalities of these factors in ethnic minority communities. The Composite Reach Index is a separate indicator. This indicator summarizes the coverage of maternal health (SKM) services and reproductive health services. This index includes 09 sub-indices: the rate of access to antenatal care services (at least 1 antenatal checkup), the rate of access to antenatal care services (at least 4 antenatal checkups), prenatal care within the first 16 weeks of pregnancy, content of care and support by qualified medical staff during childbirth, childbirth at health facilities, newborn health checks within 48 hours after giving birth, use modern contraception and health insurance. Overall, the composite coverage ratio of reproductive health services for ethnic minority women participating in the study was 46%, with significant variation between groups, ranging from below 35% to over 80%. The composite access index can be used as an intermediate indicator of progress in achieving the goal of universal access to health care services (maximum value of this index 100%). ).
Linear regression analysis was performed to identify important variables in the rate of access to and use of maternal and child health services. The results show that all five socio-economic factors determining health in this study have a statistically significant relationship (p < 0.001) with the rate of access to maternal and child health services.
Presenting the results of more than 30 indicators of maternal health care and family planning service use by ethnic minority women, the study shows that inequality exists across all ethnic minority groups compared with national data. The biggest difference is the rate of using prenatal care services (at least 4 antenatal check-ups), the percentage of women giving birth at health facilities, the percentage of births with staff support. trained health professionals and specific contents of CSTS services. Inequalities also exist in CSTS for at least once antenatal care, albeit to a lesser extent than the four indicators mentioned above.
The percentage of ethnic minority women accessing antenatal care services (at least 04 antenatal care visits) is 58 percentage points lower than the national rate (16% versus 74%).
The rate of childbirth at health facilities among ethnic minority women participating in the study was 53 percentage points lower than the national estimate (41% versus 94%).
The proportion of births supported by qualified health workers was 45 percentage points lower among ethnic minority women participating in the study compared with national estimates (49% versus 94%).
The proportion of ethnic minority women participating in the study who received adequate prenatal care (e.g., blood pressure measurements, blood and urine tests) was 38 percentage points lower than the national estimate (18% vs. 56%)
Descriptive analyzes help better understand the access to maternal health care services among ethnic minority women according to health-related social factors, including: place of residence, economic status, education level and nation.
With regard to residence, the difference in service access is more than 20 percentage points between Dak Nong, Bac Kan and four other provinces (Son La, Lai Chau, Kon Tum, Gia Lai). Inequalities related to residence are not high in the four provinces with the lowest rates of access to maternal health care services.
Regarding economic status, the difference in the rate of access to maternal health care services between the richest and the poorest quintile is more than 40 percentage points; the average service access rate for the poorest quintile is 25% and that for the richest quintile is 67%.
With regard to education level, the difference in access to maternal health care services is 50 percentage points; the average access rate among the illiterate group is 25% and among those with secondary school graduates or higher it is 75%.
Regarding ethnic groups, the difference in the rate of access to maternal health care services between the Tay and other ethnic groups is 25 percentage points. Ba Na and H'mong are the groups with the lowest access rate (under 35%).
In general, the results show that there is a big difference among ethnic minority groups in the rate of integrated access to maternal health care services.