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Trends in health facility deliveries and caesarean sections by wealth quintile in Morocco between 1987 and 2012
Author(s) -
Cresswell Jenny A.,
Assarag Bouchra,
Meski FatimaZahra,
Filippi Veronique,
Ronsmans Carine
Publication year - 2015
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12466
Subject(s) - medicine , poisson regression , health facility , demography , environmental health , population , health services , sociology
Abstract Objectives To examine trends in the utilisation of facility‐based delivery care and caesareans in Morocco between 1987 and 2012, particularly among the poor, and to assess whether uptake increased at the time of introduction of policies or programmes aimed at improving access to intrapartum care. Methods Using data from nationally representative household surveys and routine statistics, our analysis focused on whether women delivered within a facility, and whether the delivery was by caesarean; analyses were stratified by relative wealth quintile and public/private sector where possible. A segmented Poisson regression model was used to assess whether trends changed at key events. Results Uptake of facility‐based deliveries and caesareans in Morocco has risen considerably over the past two decades, particularly among the poor. The rate of increase in facility deliveries was much faster in the poorest quintile (annual increase RR : 1.09; 95% CI : 1.07–1.11) than the richest quintile (annual increase RR : 1.01; 95% CI : 1.02–1.02). A similar pattern was observed for caesareans (annual increase among poorest RR : 1.13; 95% CI : 1.07–1.19 vs . annual increase among richest RR : 1.08; 95% CI : 1.06–1.10). We found no significant acceleration in trend coinciding with any of the events investigated. Conclusions Morocco's success in improving uptake of facility deliveries and caesareans is likely to be the result of the synergistic effects of comprehensive demand and supply‐side strategies, including a major investment in human resources and free delivery care. Equity still needs to be improved; however, the overall trend is positive.