Socio-demographic characteristics associated with unequal utilization of obstetric services among women living in northern Thailand

Despite many international maternal and child health campaigns, childbirth remains a very dangerous experience for women and infants in many developing countries. Childbirth-related risks are highest where there is low access to family planning, skilled birth attendants and facilities equipped to handle childbirth complications. The Thai Ministry of Public Health (2008) reports infant mortality rates are 56% higher in rural areas. Additionally, rates are expected to be much higher among ethnic minorities in Thailand. Using data from the United Nations Educational, Scientific and Cultural Organization (UNESCO) Highland Peoples' Household Survey (2010) of ethnic minority and ethnic Thai women in northern Thailand. We describe women's hospital utilization for childbirth in terms of differences by socio-demographic characteristics, including age, ethnicity, citizenship status, Thai language proficiency, and migration status. We find that hospital births are much less common among older cohorts, highland ethnic minority women, non-Thai-citizens, those with lower proficiency in the Thai language, and those without a migration history. Commonly, childbirths are considered safest at a hospital; however, the feasibility and appropriateness of this option may vary drastically between different settings in the developing world. More must be done to ensure that minority women have access to a hospital or birth attendant for childbirth and that they are able to make informed decisions about their healthcare utilization.