Inequity in maternal health care utilization in Vietnam

INTRODUCTION: Vietnam has succeeded in reducing maternal mortality in the last decades. Analysis of survey data however indicate that large inequities exist between different segments of the population. We have analyzed utilization of antenatal care and skilled birth attendance among Vietnamese women of reproductive age in relation to social determinants with the aim to reveal health inequities and identify disadvantaged groups. METHOD: Data on maternal health care utilization and social determinants were derived from the Multiple Indicator Cluster Survey (MICS) conducted in Vietnam in 2006, and analyzed through stratified logistic regressions and g-computation. RESULTS: Inequities in maternal health care utilization persist in Vietnam. Ethnicity, household wealth and education were all significantly associated with antenatal care coverage and skilled birth attendance, individually and in synergy. Although the structural determinants included in this study were closely related to each other, analysis revealed a significant effect of ethnicity over and above wealth and education. Within the group of mothers from poor households ethnic minority mothers were at a three-fold risk of not attending any antenatal care (OR 3.06, 95% CI 1.27-7.41) and six times more likely not to deliver with skilled birth attendance (OR 6.27, 95% CI 2.37-16.6). The association between ethnicity and lack of antenatal care and skilled birth attendance was even stronger within the non-poor group. CONCLUSIONS: In spite of policies to out rule health inequities, ethnic minority women constitute a disadvantaged group in Vietnam. More efficient ways to target disadvantaged groups, taking synergy effects between multiple social determinants into consideration, are needed in order to assure safe motherhood for all.