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BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Care | Research article

Socioeconomic inequalities in maternal health service utilisation: a case of antenatal care in Nigeria using a decomposition approach

Authors: Chijioke O. Nwosu, John E. Ataguba

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Antenatal care (ANC) services are critical for maternal health but Nigeria performs poorly in ANC utilisation compared to other countries in sub-Saharan Africa. This study aimed to assess socioeconomic inequalities in ANC utilisation and the determinants of these inequalities in Nigeria.

Methods

The 2013 Nigeria Demographic and Health Survey data with 18,559 women was used for analysis. The paper used concentration curves and indices for different measures of ANC utilisation (no ANC visit, 1–3 ANC visits, at least four ANC visits, and the number of ANC visits). A positive (or negative) concentration index means that the measure of ANC utilisation was concentrated on the richer (poorer) population compared to their poorer (richer) counterparts. The concentration indices were also decomposed using standard methodologies to examine the significant determinants of the socioeconomic inequalities in no ANC visit, at least four ANC visits, and the number of ANC visits.

Results

No ANC visit was disproportionately concentrated among the poor (concentration index (CI) = − 0.573), whereas at least four ANC visits (CI = 0.582) and a higher number of ANC visits (CI = 0.357) were disproportionately concentrated among the rich. While these results were consistent across all the geopolitical zones and rural and urban areas, the inequalities were more prevalent in the northern zones (which also have the highest incidence of poverty in the country) and the rural areas. The significant contributors to inequalities in ANC utilisation were the zone of residence, wealth, women’s education (especially secondary) and employment, urban-rural residence, ethnicity, spousal education, and problems with obtaining permission to seek health care and distance to the clinic.

Conclusions

Addressing wealth inequalities, enhancing literacy, employment and mitigating spatial impediments to health care use will reduce socioeconomic inequalities in ANC utilisation in Nigeria. These factors are the social determinants of health inequalities. Thus, a social determinants of health approach is needed to address socioeconomic inequalities in ANC coverage in Nigeria.
Footnotes
1
Nigeria is divided into six geopolitical zones, with each geopolitical zone comprising about six states. These are North-West, North-East, North-Central, South-West, South-East and South-South. The northern zones are generally associated with a higher poverty prevalence (especially the North-West and North-East) ([24]
 
2
This was not used in the decomposition analysis because the benchmark category is ambiguous as it contains both zero visit and at least four visits.
 
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Metadata
Title
Socioeconomic inequalities in maternal health service utilisation: a case of antenatal care in Nigeria using a decomposition approach
Authors
Chijioke O. Nwosu
John E. Ataguba
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7840-8

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