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Doctoral Thesis
Inequities in the utilization of maternal healthcare services in low- and middle-income countries: comparative insights from Bangladesh and Pakistan
Doctor of Philosophy (PhD), Murdoch University
2025
Abstract
Equity in maternal healthcare is critical to achieving the United Nations Sustainable Development Goals (SDGs) by 2030. Significant inequities persist in maternal healthcare service (MHS) utilization in low- and middle-income countries (LMICs). Bangladesh and Pakistan, two lower-middle-income South Asian countries with shared political and economic challenges, continue to experience disparities in access and utilization of reproductive and maternal healthcare and healthcare financing.
This thesis critically reviews recent literature on MHS inequities in LMICs to identify gaps in evidence. It examines and compares the levels, distributions, and inequity in key MHS utilization, unmet need for family planning, and out-of-pocket (OOP) health expenses in Bangladesh and Pakistan. Using nationally representative data from Demographic and Health Surveys (DHS) 2017–2018 of both countries and Household Income and Expenditure Survey 2022 of Bangladesh, the study employed inequity measures and refined methodologies to assess disparities in MHS.
The scoping review finds gaps in comprehensive research on MHS inequities and dependency on concentration index methods with limited equity implications. In Bangladesh and Pakistan, wealth status emerged as the most significant driver of MHS inequity, followed by education and urban-rural residence. The richest wealth quintile contributed most to urban-rural inequity, accounting for 38.05% of the disparity in quality antenatal care use in Bangladesh and 18.23% in Pakistan. Young women and those from female-headed households were more likely to experience unmet need for family planning. OOP expenses for pregnancy-related care were high in both countries, especially in private facilities. Catastrophic health expenditure was prevalent, particularly among low-income and rural households in Bangladesh.
The findings underscore the necessity for specific interventions to improve maternal and reproductive healthcare by ensuring equitable utilization and prioritizing vulnerable populations. This study contributes to the literature on equity in MHS in LMICs and provides policy insights for Bangladesh, Pakistan, and other similar resource-constrained LMICs.
Details
- Title
- Inequities in the utilization of maternal healthcare services in low- and middle-income countries: comparative insights from Bangladesh and Pakistan
- Authors/Creators
- Farjana Misu
- Contributors
- Khurshid Alam (Supervisor) - Murdoch University, Centre for Healthy AgeingDomenico Gasbarro (Supervisor) - Murdoch University, Murdoch Business School
- Awarding Institution
- Murdoch University; Doctor of Philosophy (PhD)
- Identifiers
- 991005815050207891
- Murdoch Affiliation
- College of Business
- Resource Type
- Doctoral Thesis
UN Sustainable Development Goals (SDGs)
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