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Urban - rural disparities in antenatal care utilization: a study of two cohorts of pregnant women in Vietnam.

Journal article
Authors Toan K Tran
Chuc Tk Nguyen
Hinh D Nguyen
Bo Eriksson
Göran Bondjers
Karin Gottvall
Henry Ascher
Max Petzold
Published in BMC health services research
Volume 11
Issue 1
Pages 120
ISSN 1472-6963
Publication year 2011
Published at Department of Economics, Statistical Research Unit
Institute of Medicine
Pages 120
Language en
Links dx.doi.org/10.1186/1472-6963-11-120
https://gup.ub.gu.se/file/105279
Subject categories Medical and Health Sciences

Abstract

ABSTRACT: 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. Key words: Antenatal care, adequacy, disparities, urban - rural comparison, Vietnam.

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