Utilization And Equity Analysis On Health Care Services Of Hospital Delivery And Postpartum For Pregnant Women In Gansu Province

ObjectiveTo understand the status of health care services of hospital delivery and postpartum for pregnant women and puerpera in Gansu Province,and to explore related influencing factors and fairness so as to provide a scientific basis for for maternal and child health authorities to formulate relevant policies to improve maternal health and health care services.Methods4-7 townships and villages or communities in each of 10 counties of five cities in Gansu province were selected by using multistage stratified sampling as investigation sites.In each investigation site,according to the“Maternal Health Archives”provided by the selected township health centers and community health service centers,a number of women who had a childbearing history from November2013 to November 2017 were identified as survey respondents through convenient sampling.About 120 people were selected in each county(district).Face-to-face surveys were conducted using self-designed questionnaires.A total of 1229questionnaires were distributed and 1207 valid questionnaires were received.The effective response rate was 98.21%.The contents of the questionnaire included:(1)information on the basic situation of the respondents and their spouses;(2)utilization of hospital delivery services;and(3)utilization of postnatal health services.The database was built using Epidata 3.0,and statistical analysis was performed by SPSS22.0.The x~2 test was first performed on some potential influencing factors,and then the logistic regression model was used for multivariate analysis.Finally,the extreme difference and concentration index were calculated for fairness analysis.The test level was?=0.05,p<0.05 was considered statistically significant.Results1.Hospital delivery rate was 98.84%,cesarean section rate was 22.87%;postpartum health care instruction rate was 88.40%,postpartum visit rate was 38.61%,and health examination rate 42 days after delivery was 54.52%.2.The results of univariate analysis and logistic regression analysis showed that influencing factors of hospitalization delivery service utilization included the age of delivery,the distance between residence and village health office/community health service center,and the distance between residence and township health center/comprehensive medical institution.Influencing factors of postpartum visit included education level,occupation,distance between residence and village health office/community health service center and number of births.Influencing factors of postpartum health examination:education level,distance between residence and village clinics/community health service centers,distance between residence and township hospitals/comprehensive medical institution,classification of midwife institute and annual household income.3.The extreme difference and concentration index of some factors influencing hospital delivery utilization including income level,educational level,household registration,and the distance between residence and medical institution were small,and the fairness of hospital delivery was high.In terms of the utilization of postnatal visit services,the fairness of indicators such as income level,education level,household registration and distance between residence and medical institutions was lower than that of hospital delivery.The extreme differences and concentration indexes of the indicators influencing the utilization of 42-day postnatal health check-up service including income level,educational level,household registration,and the distance between the residence and the medical institution were high,and the fairness was poor.Conclusion1.Gansu Province has a higher rate of hospital delivery.Compared with the hospital delivery rate,postpartum care services are underutilized and postpartum visit rate and 42-day postpartum health check rate are lower.2.High childbirth age,low economic income,different midwifery institutions,remote areas,and the low educational level of the respondents and their spouses,rural household registration,etc.are the key factors that restrict the use of hospital delivery and postpartum health care service.3.The fairness of service utilization in different stages of maternity in Gansu Province is different.The fairness of hospital delivery service is fair,and the fairness of postpartum health care service is poor.The reasons for unfairness mainly include family income,education level,urban-rural difference and the distance between the residence and the medical institution.