Abstract
BackgroundEquitable use of reproductive health care services is of critical importance since it may affect women’s and children’s health. Policies to reduce inequality in access to reproductive health care services are often general and frequently benefit the richer population. This is known as the inverse equity situation. We analyzed the magnitude and trends in wealth-related inequalities in the use of family planning, antenatal and delivery care services in Ghana and Nigeria. We also investigate horizontal inequalities in the determinants of reproductive health care service use over the years.MethodsWe use data from Ghana’s (2003, 2008 and 2014) and Nigeria’s (2003, 2008 and 2013) Demographic and Health Surveys. We use concentration curves and concentration indices to measure the magnitude of socioeconomic-related inequalities and horizontal inequality in the use of reproductive health care services.ResultsExposure to family planning information via mass media, antenatal care at private facilities are more often used by women in wealthier households. Health worker’s assistance during pregnancy outside a facility, antenatal care at government facilities, childbirth at home are more prevalent among women in poor households in both Ghana and Nigeria. Caesarean section is unequally spread to the disadvantage of women in poorer households in Ghana and Nigeria. In Nigeria, women in wealthier households have considerably more unmet needs for family planning than in Ghana. Country inequality was persistent over time and women in poorer households in Nigeria experienced changes that are more inequitable over the years.ConclusionWe observe horizontal inequalities among women who use reproductive health care. These inequalities did not reduce substantially over the years. The gains made in reducing inequality in use of reproductive health care services are short-lived and erode over time, usually before the poorest population group can benefit. To reduce inequality in reproductive health care use, interventions should not only be pro-poor oriented, but they should also be sustainable and user-centered.
Highlights
Equitable use of reproductive health care services is of critical importance since it may affect women’s and children’s health
The distribution of the outcome variables in the poorest 20 percent, richest 20 percent and Concentration curve of household wealth-related inequality in use of reproductive health care services In Figure 1, the top image indicates that the curves of family planning information via print and TV lie distinctively furthest away from the line of equality over the observed years in Ghana, suggesting that these services are to the disadvantage of women in poor households
Antenatal care services We find that, in both Ghana and Nigeria, women in poor households have increasingly become disadvantaged as inequality in use of antenatal care at private facilities increased in favor of their counterparts in wealthy households
Summary
Equitable use of reproductive health care services is of critical importance since it may affect women’s and children’s health. Policies to reduce inequality in access to reproductive health care services are often general and frequently benefit the richer population. This is known as the inverse equity situation. The loss of healthy life years due to morbidity or mortality resulting from reproductive ill-health among pregnant women is Policies to reduce inequality in access to reproductive health care services, in Sub-Saharan African countries, often have unintended and unwanted consequences. Such as health providers preference for urban.
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