Distribution of government health financing benefits among women who delivered in public institutions in Bangladesh: a nationally representative cross-sectional study.

Background: Equitable access to institutional delivery care is crucial for reducing maternal mortality. Although Bangladesh has made progress in this regard, significant challenges persist in achieving equitable access to institutional delivery care, particularly for economically disadvantaged populations. The objective of this study was to investigate the distribution of public health financing benefits among women who delivered in public facilities in Bangladesh. Methods: This study was conducted based on the data from the Bangladesh Demographic and Health Survey (BDHS) 2022, which includes a sample of 3360 women (age 15-49 years) who had a history of institutional delivery during two years preceding the survey. Descriptive and econometric analyses, including Benefit Incidence Analysis (BIA), Concentration Curves (CC), and Concentration Indices (CIX), were employed to assess the distribution of public subsidies for delivery care among different socio-economic groups. Socioeconomic inequality in utilisation of delivery care services was evaluated using concentration curves, while BIA estimated the distribution of public healthcare benefits across wealth quintiles. Logistic regression was used to determine the factors associated with distress financing-whether the household of the women had to sell their assets or had to resort of borrowing to avail services. Findings: Among the poorest quintile, 38% utilised public facilities, compared to 17% of the women with highest income. The concentration curve for public facility use indicated a pro-poor distribution (CIX -0.031). BIA revealed that the poorest quintile received 24.5% of public subsidies, whereas the wealthiest quintile received 13.7%. However, in tertiary care facilities and for caesarean delivery, the wealthiest group benefitted the most, receiving 23.5% and 26% of the subsidies, respectively. Odds of distress financing was significantly higher among women from poorer or poorest households compared to the richest group (aOR 4.35, 95% CI 3.16-6.03 for poorest and aOR 2.74, 95% CI 2.00-3.77 for poorer). Interpretation: Public health subsidies in Bangladesh equitably benefit women with lower income, though inequities remain, particularly in tertiary care facilities and for caesarean deliveries. Despite this, women with lower income are more vulnerable to distress financing for delivery care. Funding: None.