Objective: Progress towards the Millennium Development Goals for maternal health has been slow, and accelerated progress in scaling up professional delivery care is needed. This paper describes poor-rich inequalities in the use of maternity care and seeks to understand these inequalities through comparisons with other types of health care.
Methods: Demographic and Health Survey (DHS) data from 45 developing countries were used to describe poor-rich inequalities by wealth quintiles in maternity care (professional delivery care and antenatal care), full childhood immunization coverage and medical treatment for diarrhoea and acute respiratory infections (ARI).
Findings: Poor-rich inequalities in maternity care in general, and professional delivery care in particular, are much greater than those in immunization coverage or treatment for childhood illnesses. Public-sector inequalities make up a major part of the poor-rich inequalities in professional delivery attendance. Even delivery care provided by nurses and midwives favours the rich in most countries. Although poor-rich inequalities within both rural and urban areas are large, most births without professional delivery care occur among the rural poor.
Conclusion: Poor-rich inequalities in professional delivery care are much larger than those in the other forms of care. Reducing poor-rich inequalities in professional delivery care is essential to achieving the MDGs for maternal health. The greatest improvements in professional delivery care can be made by increasing coverage among the rural poor. Problems with availability, accessibility and affordability, as well as the nature of the services and demand factors, appear to contribute to the larger poor-rich inequalities in delivery care. A concerted effort of equity-oriented policy and research is needed to address the huge poor-rich inequalities in maternity care.
Before 1800, just about everybody was poor. You had royalty, you had these huge landowners, but they were a tiny, tiny minority and just about everyone lived in poverty. And everyone lived very much wedded to their land. This was the entire history of humanity. There were some huge changes, of course: agriculture. What happened was that mostly people were hunters and gatherers before agriculture. And then, when agriculture started, food production was then brought to people rather than vice versa. People didn't go out looking for food. There were places where they knew that a steady supply of food would be created.
But at that time, also was the start of--one of the great economists, Deirdre McCloskey, talked about right around that time, with the advent of the Industrial Revolution and steam, you had the beginning of what she called the great divergence, meaning that certain areas, especially Europe and the United States, grew rich very, very quickly.
Well, if you look back into the history of how you tackle the problem of inequality, how you tackle the problem of poverty, this man, Andrew Carnegie, is a very important figure. He wrote, in a book called "The Gospel of Wealth"--he said that, "The man who dies leaving behind many millions of available wealth, which was his to administer during life will pass away unwept, unhonored, and unsung. The man who dies thus rich dies disgraced."
Let's look at another example, a very famous one of course is Albert Schweitzer. Now, I always get in trouble when I talk about Albert Schweitzer like this because people, for good reasons, admire him very much. But Albert Schweitzer was part of a different tradition. He was part of the colonialist movement. He was also a missionary. And there was this sense that it was the responsibility of people like Albert Schweitzer to bring civilization to the uncivilized masses. But Albert Schweitzer also portrayed himself as a great physician who was providing care to the poor.
In addition, we have been able to put $28 billion directly into an account that we reserve for the poorest countries. And this program is called IDA, the International Development Association. And IDA gives grants to the poorest countries. They can pay it back over 40 years. Right, very hard to get a loan that you pay back over 40 years at zero percent interest, and we do that to help countries grow. Now, that is what we have done over time.
How do we mobilize those trillions of dollars sitting on the sidelines for the benefit of the poorest people in the world? We know that the private sector has to be much more involved in development than before, because there are many, many examples of win-win situations. Let me show you one:
But this is the crisis that I am most concerned about, the human capital crisis. 400 million people lack access to essential services. 100 million people fall into poverty every year from catastrophic health expenses. Only one-third of the world's poor are covered by safety nets.
You know, when I say that 200 years ago just about everyone was poor, 50 years ago, when I was a young person--54 years ago when I was still living in Korea, there was a sense that countries like Korea, the poorest countries in the world, would always be poor, you know, the term "Poverty will always be with you."
And so, there was a huge amount of literature of how rich countries and organizations like the World Bank, how they should think about their mission with respect to poor people. And there was a huge amount of literature created.
It all goes back to this: These kids want to have a chance to become whatever they want. And I think about--you know, this is me back in 1963 living in Korea. And this is what Korea looked like in 1963, one of the poorest countries in the world, lower GDP per capita than Ghana, than Somalia, than Kenya.
And this is what the World Bank said: "Korea is so poor, they're so backward, we're not going to give them a loan because they would never be able to pay it back." They were wrong about that, of course, but that's what they said.
Opinions among Republicans and Republican leaners are more divided: 53% say hard work has more to do with why a person is rich, while 45% say it is because they have more advantages. In views of why a person is poor, 55% of Republicans say it is more because they have faced obstacles most others have not, while 42% say it is more because they have not worked as hard as most others.
Views of why people are rich have changed significantly over the past few years, with a growing share of Americans saying the main reason a person is rich is because they possess more advantages than other people.
They are getting richer at a much faster pace while the poor are still struggling to earn a minimum wage and access quality education and healthcare services, which continue to suffer from chronic under-investment.
The top 10% of the Indian population holds 77% of the total national wealth. 73% of the wealth generated in 2017 went to the richest 1%, while *670 million Indians who comprise the poorest half of the population saw only a 1% increase in their wealth.
As a result, decent healthcare is a luxury only available to those who have the money to pay for it. While the country is a top destination for medical tourism, the poorest Indian states have infant mortality rates higher than those in sub-Saharan Africa. India accounts for 17% of global maternal deaths, and 21% of deaths among children below five years.
Where would you rather live? A society where the rich are extraordinarily rich and the poor are very poor, or one where the rich are merely very well off but even those on the lowest incomes also enjoy a decent standard of living?
Britain is a different story. While the top earners rank fifth, the average household ranks 12th and the poorest 5 per cent rank 15th. Far from simply losing touch with their western European peers, last year the lowest-earning bracket of British households had a standard of living that was 20 per cent weaker than their counterparts in Slovenia.
Rich Dad Poor Dad is written in the style of a set of parables, ostensibly based on Kiyosaki's life.[1] The titular "rich dad" is his best friend's father who accumulated wealth due to entrepreneurship and savvy investing, while the "poor dad" is claimed to be Kiyosaki's own father who he says worked hard all his life but never obtained financial security.
The story begins with the author as a young boy, observing the contrasting financial mindsets and behaviors of his two dads. His poor dad, who held a high position in education, emphasized the importance of academic success, job security, and living within one's means. On the other hand, his rich dad, a successful entrepreneur, believed in building assets, investing wisely, and acquiring financial knowledge.
Throughout the book, Kiyosaki shares anecdotes and conversations that he had with his rich dad, who guided him on various aspects of money, wealth creation, and financial independence. He learns valuable lessons about the difference between assets and liabilities, the power of financial education, and the importance of taking calculated risks.Kiyosaki emphasizes the significance of acquiring assets that generate income, such as real estate and businesses, as opposed to liabilities that drain money, such as excessive consumer debt and unnecessary expenses. He introduces concepts like the cash flow quadrant, which categorizes individuals as employees, self-employed, business owners, or investors, highlighting the advantages and disadvantages of each quadrant.
The main inequality measures we used are the rate ratio (RR) and the rate difference (RD). The RR gives the ratio of health care use among the richest to the poorest group within a country, whereas the RD gives the absolute difference in health care use between these groups.
We estimated the distribution of the total number of births without a professional delivery attendant across the rural poor, rural rich, urban poor and urban rich. This was done by calculating the total number of deliveries without a professional delivery attendant in each of the groups as a proportion of the total number of deliveries without such an attendant in the total survey population. For this analysis, the poor were defined as the bottom 50% of the total survey population.
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