Addressing the huge poor-rich gap of inequalities in accessing safe childbirth care: A first step to achieving universal maternal health coverage in Tanzania.

Deogratius Bintabara,Federica Angeli

doi:10.1371/journal.pone.0246995

Abstract

Despite skilled attendance during childbirth has been linked with the reduction of maternal deaths, equality in accessing this safe childbirth care is highly needed to achieving universal maternal health coverage. However, little information is available regarding the extent of inequalities in accessing safe childbirth care in Tanzania. This study was performed to assess the current extent, trend, and potential contributors of poor-rich inequalities in accessing safe childbirth care among women in Tanzania. This study used data from 2004, 2010, and 2016 Tanzania Demographic Health Surveys. The two maternal health services 1) institutional delivery and 2) skilled birth attendance was used to measures access to safe childbirth care. The inequalities were assessed by using concentration curves and concentration indices. The decomposition analysis was computed to identify the potential contributors to the inequalities in accessing safe childbirth care. A total of 8725, 8176, and 10052 women between 15 and 49 years old from 2004, 2010, and 2016 surveys respectively were included in the study. There is an average gap (>50%) between the poorest and richest in accessing safe childbirth care during the study period. The concentration curves were below the line of inequality which means women from rich households have higher access to the institutional delivery and skilled birth attendance inequalities in accessing institutional delivery and skilled birth attendance. These were also, confirmed with their respective positive concentration indices. The decomposition analysis was able to unveil that household's wealth status, place of residence, and maternal education as the major contributors to the persistent inequalities in accessing safe childbirth care. The calls for an integrated policy approach which includes fiscal policies, social protection, labor market, and employment policies need to improve education and wealth status for women from poor households. This might be the first step toward achieving universal maternal health coverage.

Highlights

Despite skilled attendance during childbirth has been linked with the reduction of maternal deaths, equality in accessing this safe childbirth care is highly needed to achieving universal maternal health coverage
The calls for an integrated policy approach which includes fiscal policies, social protection, labor market, and employment policies need to improve education and wealth status for women from poor households. This might be the first step toward achieving universal maternal health coverage
Pregnancy and childbirth are normal processes they can end in complications that could lead to death, in absence of appropriate interventions to deal with lifethreatening conditions at the right time [1]

Summary

Methods

This study used data from 2004, 2010, and 2016 Tanzania Demographic Health Surveys. The two maternal health services 1) institutional delivery and 2) skilled birth attendance was used to measures access to safe childbirth care. The current study used three methods to assess inequalities in accessing safe childbirth care (measured by accessing institutional delivery and skilled birth attendance). These methods were; (1) the computation of concentration curves, (2) the computation of concentration indices, and (3) the decomposition analysis. Irrespective of her wealth status class, has the same value of safe childbirth care, the concentration curves will be a 45-degree (diagonal) line, starting from the bottom left-hand corner to the top right-hand corner. By contrast, the outcome variables (accessing institutional delivery and skilled birth attendance) take higher (lower) value among poorer women, the concentration curve will lie above (below) the line of equality. The further the curve is below the line of equality, the more concentrated the outcome variable is among the rich

Results

Discussion

Conclusion