Online Program

292172
Socio-demographic factors influencing childbirth location among marginalized communities in northern Thailand


Monday, November 4, 2013 : 3:00 p.m. - 3:15 p.m.

Stephanie Koning, B.S., Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI
Objective: Despite many health campaigns, childbirth remains dangerous for women and infants in many developing countries. Childbirths are safest in hospitals and with skilled attendants; however, many childbirths still occur in homes. We analyze the association between socio-demographic characteristics, including ethnicity, schooling, and citizenship, and hospital births, an ongoing contributor to health disparities in the development context. Design: Using hierarchical logistic regression, we measure women's odds of hospital births and differentiate these odds by socio-demographic characteristics—specifically ethnicity, education level and language—with and without potential confounders included. Population: We analyze data from the United Nations Educational, Scientific and Cultural Organization Highland Peoples Survey (2010) of 13,534 ethnic Thai and minority women living in highland villages near the Thai-Burma border, a population never before surveyed for health and socioeconomic information. Principal findings: Women's odds of giving birth in a hospital are significantly lower (p<0.01) by 90% when they do not have citizenship, 39% when they are a minority, 50% when they have not had any schooling (compared to having finished upper secondary school), 30% if Thai is not spoken at home, and 49% if a minority language is spoken at home. Conclusions: Maternal and child health disparities exist in Thailand, likely due to unequal access to and unequal utilization of obstetric care services between women of different ethnicities, legal statuses, education levels, and language abilities. Implications: Cultural competence and language services in hospitals must improve and education access, healthcare coverage, and citizenship eligibility must be expanded to reduce these disparities.

Learning Areas:

Diversity and culture
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Analyze the association between socio-demographic characteristics, including ethnicity, schooling, and citizenship, and hospital births, an ongoing contributor to health disparities in the development context: Measure women’s odds of hospital births and differentiate these odds by socio-demographic characteristics—specifically ethnicity, education level and language—with and without potential confounders included.

Keyword(s): Maternal Health, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be a presenter because I am currently a doctoral student in population health sciences and a health data analyst for the United Nations, Educational, Scientific, and Cultural Organization Highland Peoples Survey, based in Thailand. I have done public health research in Thailand for over 6 years and have been principle investigator on Canadian federally funded grants focusing on minority health in southeast Asia.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.