Abstract
BackgroundInequities in maternal health services utilization constitute a major challenge in maternal mortality reduction in Ethiopia. We sought to assess magnitude, trends, and determinants of inequities in maternal health services utilization in Ethiopia from 2000 to 2016.MethodsThe study utilized data from the 2000 and 2016 Ethiopia Demographic and Health Surveys, which were done based on a cross sectional survey design. The wealth-related inequities were assessed by concentration curve and horizontal inequity indices. Trends in inequities were assessed by comparing the concentration indices of maternal health services utilization variables between the 2000 and 2016 surveys using Wagstaff two groups concentration indices comparison method. Finally, the inequities were decomposed into its contributing factors using Wagstaff method of analysis.ResultsWealth-related inequities were significantly high in 2016: with horizontal inequities indices and residual regression error of antenatal care, skilled birth attendance, and postnatal care service utilization (− 0.09 and − 0.01), (− 0.06 and 0.01), and (− 0.11 and 0.0001), respectively. These indices increased significantly in 2016 when it is compared with the 2000 indices’ with the respective concentration indices difference of − 0.05, 0.05, and − 0.07. The related all p-values were < 0.0001. The main determinants of inequities were low-economic status, illiteracy, rural residence, no occupation, and fewer accesses to mass media.ConclusionsIn Ethiopia, maternal health services utilization inequities were significantly high and increased in 2016 compared to 2000. Women who are poor, rural resident, uneducated, unemployed, and fewer mass media exposed are the most disadvantaged. Targeting maternal health interventions for the underserved women is essential to reduce maternal mortality in the country.
Highlights
Inequities in maternal health services utilization constitute a major challenge in maternal mortality reduction in Ethiopia
Since wealth index (WI) variable was not available in the 2000 Ethiopia Demographic and Health Surveys (EDHS) data, we constructed the WI variable using the Principal Component Analysis (PCA) as a measure of socioeconomic status used in DHS reports of many countries [26]
Demographic and socio-economic characteristics of respondents The study participants in Ethiopia DHS were taken from the nine geographic regions and two administrative states (Addis Ababa City administration and Dire Dawa city council)
Summary
Inequities in maternal health services utilization constitute a major challenge in maternal mortality reduction in Ethiopia. Understanding the current status, trend, and contributing factors of inequities in maternal health service utilization is crucial to achieve the Sustainable Development Goal (SDG) that aims to reduce maternal mortality to 70 per 100,000 live births by 2030 [16]. The aims of this study were to assess the magnitude, trends, and determinants of inequities in maternal health services utilization in Ethiopia using nationally representative data that became available recently. Such that, the country’s progress towards achieving sustainable development goals can be tracked
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