Inequality in the use of maternal and child health services in the Philippines: do pro-poor health policies result in more equitable use of services?

BACKGROUND: The Philippines failed to achieve its Millennium Development Goal (MDG) commitment to reduce maternal deaths by three quarters. This, together with the recently launched Sustainable Development Goals (SDGs), reinforces the need for the country to keep up in improving reach of maternal and child health (MCH) services. Inequitable use of health services is a risk factor for the differences in health outcomes across socio-economic groups. This study aims to explore the extent of inequities in the use of MCH services in the Philippines after pro-poor national health policy reforms. METHODS: This paper uses data from the 2008 and 2013 Demographic and Health Survey (DHS) in the Philippines. Socio-economic inequality in MCH services use was measured using the concentration index. The concentration index was also decomposed in order to examine the contribution of different factors to the inequalities in the use of MCH services. RESULTS: In absolute figures, women who delivered in facilities increased from 2008 to 2013. Little change was noted for women who received complete antenatal care and caesarean births. Facility deliveries remain pro-rich although a pro-poor shift was noted. Women who received complete antenatal care services also remain concentrated to the rich. Further, there is a highly pro-rich inequality in caesarean deliveries which did not change much from 2008 to 2013. Household income remains as the most important contributor to the resulting inequalities in health services use, followed by maternal education. For complete antenatal care use and deliveries in government facilities, regional differences also showed to have important contribution. CONCLUSION: The findings suggest inequality in the use of MCH services had limited pro-poor improvements. Household income remains to be the major driver of inequities in MCH services use in the Philippines. This is despite the recent national government-led subsidy for the health insurance of the poor. The highly pro-rich caesarean deliveries may also warrant the need for future studies to determine the prevalence of medically unindicated caesarean births among high-income women. TRIAL REGISTRATION: Not applicable

A qualitative analysis of men’s involvement in maternal and child health as a policy intervention in rural Central Malawi

Abstract Background Men’s involvement in maternal and child health presents an opportunity for the advancement of maternal and child nutrition as men often play a key role in decision-making particularly regarding women’s reproductive health. While most research on men’s involvement in maternal and child health has focused on men’s participation in antenatal care, this study focuses specifically on men’s involvement in maternal and child nutrition. The purpose of the study is to explore how men’s involvement is conceptualised in rural Central Malawi, highlighting the key factors influencing men’s involvement in maternal and child health. Methods Focus group discussions and in-depth interviews were conducted with 26 informants and 44 community members. Critical policy was used as the theoretical framework to inform the analysis of research findings. Results In this study, we identified several factors that facilitate men’s involvement in maternal and child health, but we also identified several barriers. Facilitators of men’s involvement included: recognition by men of the impact of their involvement, pride, advocacy, incentives and disincentives and male champions. Barriers included socio-cultural beliefs, stigmatisation and opportunity costs. The study also found that there were several limitations that had unintended consequences on desired programme outcomes. These included: discriminating against women, marginalisation of married women and reinforcing men’s decision-making roles. Conclusion The study findings highlight the importance of involving men in maternal and child health for improved nutrition outcomes. We emphasise the need for nutrition policy-makers to be aware that gender dynamics are changing. It is no longer just women who are involved in nutrition activities, therefore policy-makers need to revise their approach to ensure that they consider men’s role in nutrition

The Hazard Exposure of the Maltese Islands

International comparisons of disaster risk frequently classify Malta as being one of the least hazard exposed countries. Such rankings may be criticised because: (1) they fail to take into account historic increases in population and its seasonal variation; (2) they are based on inadequately researched and incomplete historical catalogues of damaging events and (3), for small island states like Malta, they do not take into account the implications of restricted land area, which can be disproportionately impacted by even small hazardous events. In this paper, we draw upon a variety of data to discuss disaster risk in the Maltese Islands. In particular, the notion that Malta is one of the ‘safest places on earth’ is not only misleading, but also potentially dangerous because it engenders a false sense of security amongst the population. We argue that Malta is exposed to a variety of extreme events, that include: the distal effects of major earthquakes originating in southern Italy and Greece, plus their associated tsunamis; major ash producing eruptions of Mount Etna (Sicily), and their putative impacts on air transport; storm waves; coastal/inland landslides; karstic collapse; flooding and drought. In criticising international rankings of the islands’ exposure, we highlight the issues involved in formulating hazard assessments, in particular incomplete catalogues of extreme natural events. With Malta witnessing swelling resident, seasonal (i.e. tourist) plus foreign-born populations, and increases in the urban area, further research into hazards is required in order to develop evidence-based policies of disaster risk reduction (DRR)