Global Inequality in Maternal Health Care Service Utilization: Implications for Sustainable Development Goals

Abstract

Purpose: Globally, low-middle-income countries continue to account for almost all of the pregnancy-related mortalities that are largely preventable through adequate utilization of essential maternal health care services such as antenatal care (ANC) and skilled birth assistance (SBA). Promoting the use of ANC and SBA services are hindered by numerous policy- and capacity-related barriers along with widespread inequality in utilization of the existing services that further exacerbates the scenario. In an attempt to better understand the geography of inequality in service utilization, we conducted this brief descriptive study by using World Health Organization (WHO) data on ANC and SBA utilization among the member states. Methods: This was a descriptive study based on open access data on ANC and SBA use between 2012 and 2015 available through the Global Health Observatory of WHO. Country-level data were collected for Asia (41 countries), Africa (35 countries), Europe (35 countries), North America (10 countries), Latin America and the Caribbean (25 countries), and Oceania (16 countries). Cross-country and continent comparisons were made using dot and bar charts. Results: The overall prevalence of ANC and SBA use were, respectively, 78.17% and 88.33%. Considerable disparities were found in terms of ANC and SBA use across the continents, especially in Asia and Africa. Globally, the poorest performing countries included Afghanistan, Somalia, and South Sudan where more than three-quarters of the women remain deprived of ANC and SBA services during the period of 2012 and 2015. The greatest inequality in ANC use was observed in Africa (9.4% in Somalia and 99.9% in Libya), whereas that of SBA use was observed in Asia (17.8% in Afghanistan vs. 100% in Bahrain). Europe was the most equal of all regions in terms of both ANC (66.8% in Albania vs. 99.7% in Belarus) and SBA (94.4% in Denmark vs. 100% in Lithuania) use. Conclusion: Although in the majority of countries more than three-quarters of the women receive ANC and SBA services, the extent of intraregional inequality remains overwhelming especially for Asia and Africa. Progress toward maternal health-related targets should be interpreted in terms of the disparities to ensure a more even and sustainable outcome at both national and global level.

Observed trends in the magnitude of socioeconomic and area-based inequalities in use of caesarean section in Ethiopia: a cross-sectional study

“…Using both relative and absolute inequality measures in the same study has the potential to help investigate the magnitude and trend of inequality from various dimensions and perspectives. Secondly, the study presented the inequality findings for each subgroup of the equity stratifiers, and this can assist the government to identify where and how to focus their efforts towards realization of the equity-oriented SDG in relation with maternal health [36]. Specifically, the government needs to draw increased attention to women who are poor, uneducated, live in rural areas and in most regions to increase reasonable rates of the service.…”

Does economic growth reduce childhood stunting? A multicountry analysis of 89 Demographic and Health Surveys in sub-Saharan Africa

“…Interventions designed with the assumption that economic growth translates to improved child well-being also run a high risk of being ineffective. Achieving the sustainable development goals depends on getting governments to address the gap between the rich and the poor, which is still at its highest level in decades 76…”

<p>Inequities in the Uptake of Reproductive and Maternal Health Services in the Biggest Regional State of Ethiopia: Too Far from “Leaving No One Behind”</p>

“…The techniques were equity gap, equity ratio, concentration curve, and concentration index. [13][14][15][16] Equity gap was used to show absolute percentage point difference in service coverage between the highest wealth quintile and the lowest, between the highest educational levels achieved and the lowest, and between urban and rural residents. The equity ratio was calculated by dividing service coverage in the top wealth quintile by that in the bottom, and service coverage among urban by that of rural dwellers.…”

“…19 Our study findings were also comparable with the findings reported in Bangladesh and other similar settings which showed the key reproductive and maternal health services were concentrated among wealthier, more educated, and women from urban areas. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][33][34][35][36] There is inter-regional disparity in the uptake of maternal health services worldwide, with the highest disparity being in Africa and Asia regions. This has huge implications in progress towards attaining SDG targets related to maternal health.…”