Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003\u20132017

Chijioke Okoli,Mohammad Mafizur Rahman,Rasheda Khanam,Mohammad Hajizadeh

doi:10.1186/s12913-020-05700-w

Abstract

BackgroundMaternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017.MethodsThe study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15–49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between-group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services.ResultsThe RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period.ConclusionWe found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups.

Highlights

Maternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular
The results show Christians utilize more maternal healthcare services compared to Muslims and other religions
The betweengroup variance (BGV) results do not suggest any changes in absolute inequalities in antenatal care (ANC), facility-based delivery (FBD), and skilled birth assistance (SBA) utilization across the geopolitical zones over time

Summary

Introduction

Maternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. Despite continual efforts to reduce maternal mortality burden globally, it has remained an ongoing tragedy in many low-income countries, especially in Africa [1,2,3,4], which has the highest rate of maternal deaths in the world and sub-Saharan Africa as a primary contributor has a maternal death of 1 in every 16 pregnant women compared with 1 in 2800 in the developed countries [5] This substantial difference is one of the largest inequalities of any public health statistics [6]. Social inequalities that prevail in the health sector especially between the poor and the rich continue to be a cause for concern, in the developing worlds [7] These inequalities are manifested in health outcomes as studies in developing countries show that maternal health service utilization is higher among wealthier women than their poorer counterparts [7,8,9], mostly residing in rural areas [10]. Of equal importance, is socioeconomic status, which influences the use of health services as the wealthier urban women access healthcare more compared to their poorer rural counterparts

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Conclusion