Antenatal care use in Brazil and India: scale, outreach and socioeconomic inequality.

This paper investigates the extent of socioeconomic inequalities in antenatal care use and related medical procedures in Brazil and India, which represent transition economies with contrasting geographical and sociocultural composition and health care provision. Concentration indices and regression analyses applied on recent Demographic Health Survey data reveal high and proportionate distribution of antenatal coverage in Brazil, whereas the Indian case present problems of both scale and equity. Inequalities in access to four or more antenatal visits are significantly pronounced in India, and in Brazil the differences are significant only for those who had six or more visits. Brazil's universal healthcare model which proved effective in promoting equitable distribution of antenatal care could be implemented in India. Future interventions should emphasis quality of care in monitoring essential antenatal services especially targeting the poor and deprived communities.

Community factors affecting rising caesarean section rates in developing countries: an analysis of six countries.

Caesarean section rates have risen dramatically in several developing countries, especially in Latin America and South Asia. This raises a range of concerns about the use of caesarean section for non-emergency cases, not least the progressive shift of resources to non-essential medical interventions in resource-poor settings and additional health risks to mothers and newborns following a caesarean section. There are only a few studies that have systematically examined the factors influencing the recent increase in caesarean rates. In particular, it is not clear whether high elective caesarean rates are driven by medical, institutional or individual and family decisions. Where a woman's decisions predominate her interaction with peers and significant others have an impact on her caesarean section choices. Using random intercept logistic regression analyses, this paper analyses the institutional, socio-economic and community factors that influence caesarean section in six countries: Bangladesh, Colombia, Dominican Republic, Egypt, Morocco and Vietnam. The analyses, based on data from over 20,000 births, show that women of higher socio-economic background, who had better access to antenatal services are the most likely to undergo a caesarean section. Women who exchange reproductive health information with friends and family are less likely to experience a caesarean section than their counterparts. The study concludes that there is a need to pursue community-based approaches for curbing rising caesarean section rates in resource-poor settings.

Diversity in family planning use among ethnic groups in Guatemala.

This study investigates the ethnic differentials in contraceptive use in the north-eastern Ch'orti area of Guatemala, a region dominated by the Ladino culture. Data come from a household survey and in-depth interviews with service providers carried out in 2001 in the town of Jocotán, and a survey carried out in 1994 in two nearby indigenous villages (aldeas). Descriptive analysis and logistic regression are used to explore the data. Previous DHS surveys have used dress and language to classify ethnic groups. In this paper, an alternative approach based on self-identification is adopted. The results reveal significant differences in contraceptive behaviour among different ethnic groups within the same town and region. The results show that self-identified Ladino women who represented the minority of the population had contraceptive behaviour similar to their counterparts elsewhere in Latin America. The extremely low levels of contraceptive use among indigenous women from the aldeas suggest that the corresponding DHS figures in this region are probably overestimated.