Abstract
BackgroundFamily planning and maternal care services have become increasingly available in West Africa but the level of non-use remains high. This unfavorable outcome may be partly due to the unaffordability of reproductive health care services.MethodsUsing the Demographic Health Survey data from Burkina Faso, Niger, Nigeria, Ghana, and Senegal, we perform a decomposition analysis to quantify the contribution of socio-demographic characteristics to disparities in exposure to mass media information on family planning, use of modern contraceptives, adequate antenatal care visits, facility-based childbirth and C-section between low-wealth and high-wealth women.ResultsOur study shows that differences in maternal characteristics between the wealth groups explain at least 40% of the gap in exposure to mass media family planning information, 30% in modern contraceptive use, 24% of adequate antenatal care visits, 47% of the difference in facility-based childbirths, and 62% in C-section. Lack of information on pregnancy complications, living in rural residence, religion, lack of autonomy in health facility seeking decision, need to pay, and distance explains the disparity in reproductive health care use across all countries. In countries with complete fee exemption policies for specific groups in the population, Ghana, Niger, and Senegal, the inequality gaps between wealth groups in having an adequate number of antenatal care visits and facility-based childbirth are smaller than in countries with partial or no exemption policies. But this is not the case for C-section.ConclusionsThere is evidence that current policies addressing the cost of maternal care services may increase the wealth-based inequality in maternal care use if socio-demographic differences are not addressed. Public health interventions are needed to target socio-demographic disparities and health facility seeking problems that disadvantage women in poor households.
Highlights
Planning and maternal care services have become increasingly available in West Africa but the level of non-use remains high
This study focuses on the gaps in the use of reproductive health care in five countries in West Africa, namely Burkina Faso, Ghana, Niger, Nigeria, and Senegal
More women in the high-wealth group reside in urban residences in Nigeria, Ghana, Senegal compared with Burkina Faso and Niger
Summary
Planning and maternal care services have become increasingly available in West Africa but the level of non-use remains high. This unfavorable outcome may be partly due to the unaffordability of reproductive health care services. Many low- and middle-income countries have made efforts to foster equal access to health care. These efforts have not attained similar results [1]. Tsui Amy, Brown [2] provide evidence of the differences in the use of modern contraceptives within and across sub-Saharan African countries. Evidence shows that the most vulnerable - the poor - are at a disadvantage, which prevents equal access to care [3,4,5]
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