Family planning, antenatal and delivery care: cross-sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low- and middle-income countries

Oona M R Campbell, Lenka Benova, David MacLeod, Rebecca F Baggaley, Laura C Rodrigues, Kara Hanson, Timothy Powell-Jackson, Loveday Penn-Kekana, Reen Polonsky, Katharine Footman, Alice Vahanian, Shreya K Pereira, Andreia Costa Santos, Veronique G A Filippi, Caroline A Lynch, Catherine Goodman

Research output: Contribution to journalA1: Web of Science-article

Abstract

OBJECTIVE: The objective of this study was to assess the role of the private sector in low- and middle-income countries (LMICs). We used Demographic and Health Surveys for 57 countries (2000-2013) to evaluate the private sector's share in providing three reproductive and maternal/newborn health services (family planning, antenatal and delivery care), in total and by socio-economic position.

METHODS: We used data from 865 547 women aged 15-49, representing a total of 3 billion people. We defined 'met and unmet need for services' and 'use of appropriate service types' clearly and developed explicit classifications of source and sector of provision.

RESULTS: Across the four regions (sub-Saharan Africa, Middle East/Europe, Asia and Latin America), unmet need ranged from 28% to 61% for family planning, 8% to 22% for ANC and 21% to 51% for delivery care. The private-sector share among users of family planning services was 37-39% across regions (overall mean: 37%; median across countries: 41%). The private-sector market share among users of ANC was 13-61% across regions (overall mean: 44%; median across countries: 15%). The private-sector share among appropriate deliveries was 9-56% across regions (overall mean: 40%; median across countries: 14%). For all three healthcare services, women in the richest wealth quintile used private services more than the poorest. Wealth gaps in met need for services were smallest for family planning and largest for delivery care.

CONCLUSIONS: The private sector serves substantial numbers of women in LMICs, particularly the richest. To achieve universal health coverage, including adequate quality care, it is imperative to understand this sector, starting with improved data collection on healthcare provision.

Original languageEnglish
JournalTropical Medicine and International Health
Volume21
Issue number4
Pages (from-to)486-503
Number of pages18
ISSN1360-2276
DOIs
Publication statusPublished - 2016
Externally publishedYes

Keywords

  • Adolescent
  • Adult
  • Contraception
  • Cross-Sectional Studies
  • Delivery, Obstetric
  • Developing Countries
  • Family Planning Services
  • Female
  • Global Health
  • Health Equity
  • Health Services Needs and Demand
  • Healthcare Disparities
  • Humans
  • Infant, Newborn
  • Maternal Health Services
  • Middle Aged
  • Pregnancy
  • Prenatal Care
  • Private Sector
  • Public Sector
  • Socioeconomic Factors
  • Young Adult

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