Skip to main content
Top
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

Examining changes in maternal and child health inequalities in Ethiopia

Authors: Alemayehu A. Ambel, Colin Andrews, Anne M. Bakilana, Elizabeth M. Foster, Qaiser Khan, Huihui Wang

Published in: International Journal for Equity in Health | Issue 1/2017

Login to get access

Abstract

Background

Ethiopia has made considerable progress in maternal, newborn, and child health in terms of health outcomes and health services coverage. This study examined how different groups have fared in the process. It also looked at possible factors behind the inequalities.

Methods

The study examined 11 maternal and child health outcomes and services: stunting, underweight, wasting, neonatal mortality, infant mortality, under-5 mortality, measles vaccination, full immunization, modern contraceptive use by currently married women, antenatal care visits, and skilled birth attendance. It explored trends in inequalities by household wealth status based on Demographic and Health Surveys conducted in 2000, 2005, 2011, and 2014. The study also investigated the dynamics of inequality, using concentration curves for different years. Decomposition analysis was used to identify the role of proximate determinants.

Results

The study found substantial improvements in health outcomes and health services: Although there is still a considerable gap between the rich and the poor, inequalities in health services have been reduced. However, child nutrition outcomes have mainly improved for the rich. The changes observed in wealth-related inequality tend to reflect the changing direct effect of household wealth on child health and health service use.

Conclusions

The country’s efforts to improve access to health services have shown some positive results, but attention should now turn to service quality and to identifying multisectoral interventions that can change outcomes for the poorest.
Appendix
Available only for authorised users
Literature
4.
go back to reference Wagstaff A, Bredenkamp C, Buisman LR. Progress on global health goals: are the poor being left behind. World Bank Res Obs. 2014;29(2):137–62.CrossRef Wagstaff A, Bredenkamp C, Buisman LR. Progress on global health goals: are the poor being left behind. World Bank Res Obs. 2014;29(2):137–62.CrossRef
5.
go back to reference Onarheim KH, Tessema S, Johansson KA, Eide KT, Norheim OF, Miljeteig I. Prioritizing child health interventions in Ethiopia: modeling impact on child mortality, life expectancy and inequality in age at death. PLoS One. 2012;7(8):e41521.CrossRefPubMedPubMedCentral Onarheim KH, Tessema S, Johansson KA, Eide KT, Norheim OF, Miljeteig I. Prioritizing child health interventions in Ethiopia: modeling impact on child mortality, life expectancy and inequality in age at death. PLoS One. 2012;7(8):e41521.CrossRefPubMedPubMedCentral
6.
go back to reference Wilunda C, Putoto G, Manenti F, Castiglioni M, Azzimonti G, Edessa W, Criel B. Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia: a cross sectional study. Int J Equity Health. 2013;12:27.CrossRefPubMedPubMedCentral Wilunda C, Putoto G, Manenti F, Castiglioni M, Azzimonti G, Edessa W, Criel B. Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia: a cross sectional study. Int J Equity Health. 2013;12:27.CrossRefPubMedPubMedCentral
8.
go back to reference Yesuf EA, Calderon-Margalit R. Disparities in the use of antenatal care service in Ethiopia over a period of fifteen years. BMC Pregnancy Childbirth. 2013;13:131.CrossRefPubMedPubMedCentral Yesuf EA, Calderon-Margalit R. Disparities in the use of antenatal care service in Ethiopia over a period of fifteen years. BMC Pregnancy Childbirth. 2013;13:131.CrossRefPubMedPubMedCentral
9.
go back to reference Mirkuzie AH. Exploring inequities in skilled care at birth among migrant population in a metropolitan city, Addis Ababa, Ethiopia; a qualitative study. Int J Equity Health. 2014;13(1):110.CrossRefPubMedPubMedCentral Mirkuzie AH. Exploring inequities in skilled care at birth among migrant population in a metropolitan city, Addis Ababa, Ethiopia; a qualitative study. Int J Equity Health. 2014;13(1):110.CrossRefPubMedPubMedCentral
11.
go back to reference McKinnon B, Harper S, Kaufman J, Bergevin Y. Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis. Lancet Glob Health. 2004;2(3):e165–73.CrossRef McKinnon B, Harper S, Kaufman J, Bergevin Y. Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis. Lancet Glob Health. 2004;2(3):e165–73.CrossRef
12.
go back to reference Moser K, Frost C, Leon DA. Comparing health inequalities across time and place raute ratios and rate differences lead to different conclusions: analysis of cross-sectional data from 22 countries 1991-2001. Int J Epidemiol. 2001;36:1285–91.CrossRef Moser K, Frost C, Leon DA. Comparing health inequalities across time and place raute ratios and rate differences lead to different conclusions: analysis of cross-sectional data from 22 countries 1991-2001. Int J Epidemiol. 2001;36:1285–91.CrossRef
13.
go back to reference Kakwani N, Wagstaff A, van Doorslaer E. Socioeconomic inequalities in health: measurement, computation and statistical inference. J Econ. 1997;77:87–103.CrossRef Kakwani N, Wagstaff A, van Doorslaer E. Socioeconomic inequalities in health: measurement, computation and statistical inference. J Econ. 1997;77:87–103.CrossRef
14.
go back to reference Kjellsson G, Gerdtham UG. On correcting the concentration index for binary variables. J Health Econ. 2012;32:659–70.CrossRefPubMed Kjellsson G, Gerdtham UG. On correcting the concentration index for binary variables. J Health Econ. 2012;32:659–70.CrossRefPubMed
15.
go back to reference O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, DC: World Bank; 2008. O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, DC: World Bank; 2008.
16.
go back to reference Wagstaff A, van Doorslaer E, Watanabe N. On decomposing health sector inequalities, with an application to malnutrition inequalities in Vietnam. J Econometrics. 2003;112:207–23.CrossRef Wagstaff A, van Doorslaer E, Watanabe N. On decomposing health sector inequalities, with an application to malnutrition inequalities in Vietnam. J Econometrics. 2003;112:207–23.CrossRef
17.
go back to reference Khan Q, Faguet JP, Ambel A. Blending top-down federalism with bottom-up engagement to reduce inequality in Ethiopia. World Dev. 2017;96:326–42.CrossRef Khan Q, Faguet JP, Ambel A. Blending top-down federalism with bottom-up engagement to reduce inequality in Ethiopia. World Dev. 2017;96:326–42.CrossRef
19.
go back to reference Wang H, Tesfaye R, Gandham NVR, Chekagn CT. Ethiopia health extension program: an institutionalized community approach for universal health coverage. Washington, DC: World Bank; 2016.CrossRef Wang H, Tesfaye R, Gandham NVR, Chekagn CT. Ethiopia health extension program: an institutionalized community approach for universal health coverage. Washington, DC: World Bank; 2016.CrossRef
20.
go back to reference Ruel MT, Alderman H. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition. Lancet. 2013;382(9891):536–51.CrossRefPubMed Ruel MT, Alderman H. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition. Lancet. 2013;382(9891):536–51.CrossRefPubMed
Metadata
Title
Examining changes in maternal and child health inequalities in Ethiopia
Authors
Alemayehu A. Ambel
Colin Andrews
Anne M. Bakilana
Elizabeth M. Foster
Qaiser Khan
Huihui Wang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0648-1

Other articles of this Issue 1/2017

International Journal for Equity in Health 1/2017 Go to the issue