Inequality in the Continuum of Maternal Health Service Utilisation in 16 Sub-Saharan African Countries

Anteneh Asefa, Institute of Tropical Medicine, Antwerp
Samson Gebreselassie
Tiara Marthias, School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
Barbara McPake, School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
Lenka Benova, Institute of Tropical Medicine, Antwerp

Persistent inequalities in maternal health in sub-Saharan Africa poses a challenge for countries to achieve the Sustainable Development Goal targets. We conducted a secondary analysis of Demographic and Health Survey data from 16 countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia) to assesses wealth-based inequalities in coverage of maternal continuum of care. A total of 133,709 women who reported a live birth in the five years preceding the survey were included. We defined completion of maternal continuum of care as having had at least one antenatal care visit, birth in a health facility, and postnatal care within two days of birth. We used concentration index (CI) to measure wealth-based inequality and decomposition analysis to estimate the contributions of various factors to the observed inequality. Completion of maternal continuum of care was highest in South Africa (81.4%) and lowest in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (CI=0.04) and the highest in Nigeria (CI=0.34). Wealth index was the largest contributor to inequality in 15 countries. Multidimensional approaches are needed to minimise the inequality.

Keywords: Inequality, Disadvantage and Discrimination, Sexual and Reproductive Health and Rights, Decomposition analysis, Comparative methods

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