Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Socioeconomic inequalities in the uptake of maternal healthcare services in Ethiopia

Authors: Markos Mezmur, Kannan Navaneetham, Gobopamang Letamo, Hadgu Bariagaber

Published in: BMC Health Services Research | Issue 1/2017

Login to get access

Abstract

Background

The progress in coverage of maternal health services in Ethiopia has been rather slow over the past decade and consequently the maternal mortality ratio was very high (673 per 100,000 live births) among the countries in Sub-Saharan Africa and remained constant during 2005–11 period. Earlier studies have mostly focused on determinants of maternal health seeking behavior in Ethiopia. However, little is known about the inequality aspects. This study intends to examine socioeconomic inequalities in the uptake of maternal health services and to identify factors that contribute to such inequalities.

Methods

Data for the study is drawn from three rounds (year 2000, 2005 and 2011) of the Ethiopian Demographic and Health Surveys (EDHS). Concentration curves and the related concentration index (CI) were used to capture inequalities across the full range of socioeconomic status and highlight trends in the uptake of maternal health services in the country. Decomposition analysis was also employed to identify dominant factors that contribute to inequalities in the uptake of maternal healthcare services.

Results

In this study, there is a general improvement in the uptake of maternal health services in Ethiopia over the past decade which is inequitable to the disadvantage of the poor. Inequalities are much larger in care during giving birth than in other maternal healthcare indicators. Furthermore, despite the progress made in reducing inequalities in the uptake of four antenatal care consultation (ANC) and tetanus toxoid (TT) injection, inequalities in access to health facilities for delivery and skilled assistance during delivery have rather widened over the same period. In all the survey years, inequalities in education and media access significantly contribute to inequalities in maternal health service utilization favoring the non-poor.

Conclusion

The challenges to improving the uptake of maternal healthcare services in Ethiopia go beyond improving coverage of the maternal health services. Thus, addressing socioeconomic inequalities in accessing maternal health services is central to resolving challenges of maternal health. Furthermore, as Ethiopia moves forward with the sustainable development agenda, socioeconomic inequalities in uptake of maternal health services should also be continuously monitored.
Footnotes
1
Type of place of residence was not used as a standardizing variable in the analysis. As Barros AJD, Victoria CG (2013) indicated among the limitations of using asset indices as socio-economic position indicators is families in the wealthiest quintile in most low- and middle-income countries are mainly from urban areas that results in highly unbalanced groups and wealth inequalities are closely associated with urban/ rural disparities. In the Ethiopian case, the distribution of wealth quintile varies sharply by type of place of residence. For example, while 88% of the urban population in Ethiopia is in the highest wealth quintile, only 5% of the rural population is in the highest wealth quintile in the year 2011. This comprises an insignificant proportion given that the country is one of the least urbanized countries with only 16% of the population living in urban areas (CSA, 2011). Murray, C.J.L., Gakidou, E.E,.&Frenk, J. (1999) further noted when the geographical areas used to categorize the population are small and represent relatively homogeneous groups, categorization of the population by these measures provide results close to revealing the extent of individual level variation in the population.
 
Literature
1.
Marmo M, Wilkinson R. Social determinants of Health (Second ed.). New York: Oxford University press; 2006.
2.
Seccombe K, Lockwood R. Life after Welfare in Rural Communities and Small Towns- Planning for Health Insurance. Res SocHealth Care. 2003;21:195–210.CrossRef
3.
Ahmed S, Creanga A, Gillespie G, Tsui A. Economic Status, Education and Empowerment- Implications for Maternal Health Service Utilization in Developing Countries. Plos One. 2010;5:6.
4.
5.
Hosseinpoor A, Victora C, Bergen N, Barros A, Boerma T. Towards universal health coverage- the role of within-country wealth-related inequality in 28 countries in sub-Saharan Africa. Bull World Health Organ. 2011;89:881–90.CrossRefPubMedPubMedCentral
6.
Singh P, Kumar C, Rai K, Singh L. Factors associated with maternal healthcare services utilization in nine high focus states in India: a multilevel analysis based on 14385 communities in 292 districts. Health Policy Plan. 2013;1:18.
7.
Jat R, Ng N, Sebastian S. Factors affecting the use of maternal health services in Madhya Pradesh state of India: a multilevel analysis. Int J Equity Health. 2011;10:59.CrossRefPubMedPubMedCentral
8.
Osorio A, Tovar M, Rathmann K. Individual and local level factors and antenatal care use in Colombia: a multilevel analysis. Cad SaúdePública Rio de Janeiro. 2014;30(5):1079–92.CrossRef
9.
Tarekegn M, Lieberman S, Giedraitis V. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic Health Survey. BMC Pregnancy Childbirth. 2014;14:61.CrossRef
10.
Fekadu M, Regassa N. Skilled delivery care service utilization in Ethiopia: analysis of rural-urban differentials based on national demographic and health survey (DHS) data. Afr Health Sci. 2014;4:974–84.
11.
Worku G, Yalew W, Afework F. Factors Affecting Utilization of Skilled Maternal Health Care in Northwest Ethiopia: a multilevel analysis. BMC Int Health Human Rights. 2013;13:20.CrossRef
12.
Aliy J, Hailemariam D. Determinants of equity in utilization of maternal health services in Butajira Southern Ethiopia. Ethiop J Health Dev. 2012;26(Special Issue):265–70.
13.
Sepheri, et al. How important are individual, household and commune characteristics in explaining utilization of maternal health services in Vietnam. Soc Sci Med. 2008: 67:1009–1017.
14.
Sagna L, Sunil S. Effects of individual and neighborhood factors on maternal care in Cambodia. Health Place. 2012;18:415–23.CrossRefPubMed
15.
Regassa N. Antenatal and postnatal care service utilization in southern Ethiopia: a population-based study. Afr Health Sci. 2011;11:390–7.PubMedPubMedCentral
16.
Tsegay Y, Gebrehiwot T, Goicolea I, Edin K, Lemma H, Sebastian S. Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia: a cross-sectional study. Int J Equity Health. 2013;12:30.CrossRefPubMedPubMedCentral
17.
Birmeta K, Dibaba Y, Woldeyohannes D. Determinants of maternal health care utilization in Holeta town, central Ethiopia. BMC Health Servi Res. 2013;13(256):1–10.
18.
Stephenson R, Baschieri A, Clements S, Hennink M, Madise N. Contextual influences on the use of health facilities for childbirth in Africa. Am J Public Health. 2006;96:1.CrossRef
19.
20.
Babalola S, Fatusi A. Determinants of use of maternal health services in Nigeria—looking beyond individual and household factors. BMC Pregnancy Childbirth. 2009;9:43.CrossRefPubMedPubMedCentral
21.
Prusty K, Gouda J, Pradhan R. Inequality in the Utilization of Maternal Healthcare Services in Odisha, India. Int J Popul Res. 2015;2005:10.
22.
Tadese F, Ali A. Determinants of use of skilled birth attendance among mothers who gave birth in the Past 12 months in Raya Alamata District, North East Ethiopia. Clinics Mother Child Health (CMCH). 2014;11:2. an open access journal.
23.
UNFPA. Trends in Maternal Health in Ethiopia: in-depth Analysis of the EDHS 2000–2011. Ethiopia: United Nations Population Fund; 2012.
24.
25.
Dibaba A, Hadis M, Ababor S, Assefa Y. Improving health care financing in Ethiopia: An evidence-based policy brief. Addis Ababa Ethiopia. Ethiopian Public Health Institute. 2014. Retrieved on June, 7, 2015 from www.​evipnet.​org/​sure.
26.
27.
Central Statistical Agency [Ethiopia] and ICF International. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA. 2012. Retrived on the 22 November, 2016 from http://​www.​dhsprogram.​com.
28.
Abeje G, Azage M, Stegen T. Factors associated with institutional delivery service utilization among mothers in Bahir Dar city administration, Amhara region: a community based cross sectional study. Reprod Health J. 2014;11(22).
29.
Amano A, Gebeyehu A, Birhanu Z. Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study. 2012. BMC Pregnancy Childbirth. 12:105.
30.
Worku AG, Yalew AW, Afework MF. Factors Affecting Utilization of Skilled Maternal Health Care in Northwest Ethiopia: a multilevel analysis. 2013. BMC Int Health Hum Rights. 13:20.
31.
32.
Limwattananon S, Virojtangcharoensathien V, Prakongsai P. Equity in maternal and child health in Thailand. Bull World Health Organ. 2010;88:420–7.CrossRefPubMed
33.
Houweling T, Ronsmans C, Campbell O, Kunsta A. Huge poor-rich inequalities in maternity care- an international comparative study of maternity and child care in developing countries. Bull World Health Organ. 2007;85:745–54.CrossRefPubMedPubMedCentral
34.
35.
36.
Barros AJ, et al. Equity in maternal, newborn, and child health interventions- a retrospective review of survey data in Countdown to 2015- a retrospective review of survey data from 54 countries. Lancet. 2012;379(9822):1225–33.CrossRefPubMed
37.
Zere E, et al. Inequities in utilization of maternal health interventions in Namibia: implication for progress towards MDG 5 targets. Int J Equity Health. 2010;9:16.CrossRefPubMedPubMedCentral
38.
Dingle A, et al. A decade of improvement in equity of access to reproductive and maternal health services in Cambodia, 2000–2010. Int J Equity Health. 2013;12:51.CrossRefPubMedPubMedCentral
39.
Medhaneye A, et al. The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia. BMC Heath Serv Res. 2012;12:352.CrossRef
40.
Afrework MF, et al. Effects of innovative community based health program on maternal health service utilization in north and south central Ethiopia- a community based cross-sectional study. Reprod Health. 2014;11:28.CrossRef
41.
Zelelew H. Health care financing reform in Ethiopia: improving quality and equity Addis Ababa. Ethiopia: USAID; 2011.
42.
Pearson L, Gandhi M, Admassu K, Keyes E. User fees and maternity services in Ethiopia. Int J Gynaecol Obstet. 2011;115:310–5.CrossRefPubMed
Metadata
Title
Socioeconomic inequalities in the uptake of maternal healthcare services in Ethiopia
Authors
Markos Mezmur
Kannan Navaneetham
Gobopamang Letamo
Hadgu Bariagaber
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2298-9

Other articles of this Issue 1/2017

BMC Health Services Research 1/2017 Go to the issue

Research article

Risk-adjustment methods for all-payer comparative performance reporting in Vermont

Research article

Social and economic value of Portuguese community pharmacies in health care

Research article

Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees

Research article

Few opportunities to influence decisions regarding the care and treatment of an older hospitalized family member: a qualitative study among family members

Research article

Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences

Study protocol

Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project)