Browsing by Author "Ronsmans, Carine"

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Did the strategy of skilled attendance at birth reach the poor in Indonesia?
(World Health Organization, 2007-10) Hatt, Laurel; Stanton, Cynthia; Makowiecka, Krystyna; Adisasmita, Asri; Achadi, Endang; Ronsmans, Carine
Objective To assess whether the strategy of “a midwife in every village” in Indonesia achieved its aim of increasing professional delivery care for the poorest women. Methods Using pooled Demographic and Health Surveys (DHS) data from 1986–2002, we examined trends in the percentage of births attended by a health professional and deliveries via caesarean section. We tested for effects of the economic crisis of 1997, which had a negative impact on Indonesia’s health system. We used logistic regression, allowing for time-trend interactions with wealth quintile and urban/rural residence. Findings There was no change in rates of professional attendance or caesarean section before the programme’s full implementation (1986–1991). After 1991, the greatest increases in professional attendance occurred among the poorest two quintiles – 11% per year compared with 6% per year for women in the middle quintile ( P = 0.02). These patterns persisted after the economic crisis had ended. In contrast, most of the increase in rates of caesarean section occurred among women in the wealthiest quintile. Rates of caesarean deliveries remained at less than 1% for the poorest two-fifths of the population, but rose to 10% for the wealthiest fifth. Conclusion The Indonesian village midwife programme dramatically reduced socioeconomic inequalities in professional attendance at birth, but the gap in access to potentially life-saving emergency obstetric care widened. This underscores the importance of understanding the barriers to accessing emergency obstetric care and of the ways to overcome them, especially among the poor.
Household costs of healthcare during pregnancy, delivery, and the postpartum period : a case study from Matlab, Bangladesh
(ICDDR,B, 2006-12) Borghi, Josephine; Nazme, Sabina; Blum, Lauren S.; Hoque, Mohammad Enamul; Ronsmans, Carine
A household survey was undertaken in Matlab, a rural area of Bangladesh, to estimate the costs incurred during pregnancy, delivery, and the postpartum period for women delivering at home and in a health facility. Those interviewed included 121 women who delivered at home, 120 who delivered in an ICDDR,B basic obstetric care (BEOC) facility, 27 who delivered in a public comprehensive obstetric care (CEOC) hospital, and 58 who delivered in private hospitals. There was no significant difference in total costs incurred by those delivering at home and those delivering in a BEOC facility. Costs for those delivering in CEOC facilities were over nine times greater than for those delivering in BEOC facilities. Costs of care during delivery were predominant. Antenatal and postnatal care added between 7% and 30% to the total cost. Services were more equitable at home and in a BEOC facility compared to services provided at CEOC facilities. The study highlights the regressive nature of the financing of CEOC services and the need for a financing strategy that covers both the costs of referral and BEOC care for those in need.
Reliability of data on caesarean sections in developing countries
(World Health Organization, 2005-06) Stanton, Cynthia; Dubourg, Dominique; De Brouwere, Vincent; Pujades, Mar; Ronsmans, Carine
OBJECTIVE: To examine the reliability of reported rates of caesarean sections from developing countries and make recommendations on how data collection for surveys and health facility-based studies could be improved. METHODS: Population-based rates for caesarean section obtained from two sources: Demographic and Health Surveys (DHS) and health facility-based records of caesarean sections from the Unmet Obstetric Need Network, together with estimates of the number of live births, were compared for six developing countries. Sensitivity analyses were conducted using several different definitions of the caesarean section rate, and the rates obtained from the two data sources were compared. FINDINGS: The DHS rates for caesarean section were consistently higher than the facility-based rates. However, in three quarters of the cases, the facility-based rates for caesarean sections fell within the 95% confidence intervals for the DHS estimate. CONCLUSION: The importance of the differences between these two series of rates depends on the analyst’s perspective. For national and global monitoring, DHS data on caesarean sections would suffice, although the imprecision of the rates would make the monitoring of trends difficult. However, the imprecision of DHS data on caesarean sections precludes their use for the purposes of programme evaluation at the regional level.