Maternal and Child Health Inequalities in Ethiopia

Ambel, Alemayehu A.; Andrews, Colin; Bakilana, Anne Margreth; Foster, Elizabeth Mary; Khan, Qaiser M.

doi:10.1596/1813-9450-7508

Cited by 9 publications

(9 citation statements)

References 13 publications

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“…Maternal death in Ethiopia is one of the highest in the world [15] and signals substantial inequality in access to maternal health care services [16,17]. However, the country has remarkably reduced the burden of maternal and child mortalities over the last several years [15,18].…”

Section: Study Settingmentioning

confidence: 99%

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

et al. 2020

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Background: In Ethiopia, there is a paucity of studies on inequality in caesarean section using methodologically rigorous and well-established approaches. In this study, we showed extent and the overtime dynamics of inequality in caesarean section in Ethiopia following rigorous methodologies. Methods: The data for analysis came from Ethiopia Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. We used the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) to analyze the data. Caesarean delivery was disaggregated by four equity stratifiers, namely education, wealth, residence and regions. Relative and absolute summary measures were calculated for each equity stratifier to capture inequality from different perspectives. 95% Uncertainty Interval was calculated around a point estimate to measure statistical significance. Results: We found large socioeconomic and area-based inequalities in use of caesarean section in all study surveys. The inequalities have occurred in favour of socioeconomically advantaged women and those living in urban areas and certain regions such as Addis Ababa. While area-related inequality had generally increased with time, socioeconomic inequality showed fluctuation. Adoption of different measures in the study for the inequality analysis has caused the emergence of mix of patterns in caesarean section inequality over time. Conclusions: In all the surveys, wealthy and more educated women, and those residing in urban areas had higher chance of obtaining caesarean delivery. Policy makers should work to ensure caesarean section that is in the accepted normal range. More emphasis should be drawn to subpopulation with under use of caesarean section while at the same time, discouraging unjustified use of it.

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Section: Study Settingmentioning

confidence: 99%

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

et al. 2020

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“…Ethiopia, the second-most populous country in Africa, identifies both gender equality and health equity as national policy priorities. Although separate efforts have been made to assess the state of gender equality [19,20] and monitor health equity [21,22], integrated consideration of how these two priorities are pursued is lacking. Unpacking how gender is understood as a health issue and accounted for in the promotion of health equity can begin to expose how health policies, programs, and practices can be strengthened to promote gender equality in line with Ethiopia's broader health equity agenda.…”

mentioning

confidence: 99%

Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian health sector

Bergen

Zhu

Yedenekal

et al. 2020

Global Health Action

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Background: Advancing gender equality and health equity are concurrent priorities of the Ethiopian health sector. While gender is regarded as an important determinant of health, there is a paucity of literature that considers the interface between how these two priorities are pursued. Objective: This article explores how government stakeholders understand gender issues (gender barriers and roles) in the promotion of maternal, newborn and child health equity in Ethiopia. Methods: Adopting an exploratory qualitative case study design, we conducted semistructured interviews with 17 purposively-selected stakeholders working in leadership positions with the Federal Ministry of Health and Federal Ministry of Women and Children Affairs as part of a larger study regarding the promotion of health equity in maternal, newborn and child health. A post hoc content and thematic sub-analysis was done to explore how participants raised gender issues in conversations about health equity. Results: Efforts to address gender inequalities were synonymous with the promotion of a women's health agenda, which was largely oriented towards promoting health service use. Men were predominant decision makers with regards to women's health and health care seeking in both public and private spheres. Participants reported persisting gender-related barriers to health stemming from traditional gender roles, and noted the increased inclusion of women in the health workforce since the introduction of the Health Extension Program. Conclusions: The framing of gender as a women's health issue, advanced through patriarchal structures, does little to elevate the status of women, or promote power differentials that contribute to health inequity. Encouraging leadership roles for women as health decision makers and redressing certain gender-based norms, attitudes, practices and discrimination are possible ways forward in re-orienting gender equality efforts to align with the promotion of health equity. ARTICLE HISTORY

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“…It is higher (20%) in case of the long-run malnutrition indicator, low HAZ (stunting). Here, the possible reason could be due to the fact that effect of formal education is more pronounced on long-run than short -run indicator [ 12 ]. However, in case of short-run malnutrition indicator (low WHZ or wasting) and composite malnutrition indicator (low WAZ or underweight), mother education level accounts for 11 and 13% of the total contribution of observed inequalities in malnutrition.…”

Section: Resultsmentioning

confidence: 99%

“…However, these DHS-based estimates reveal increased pro-poor inequalities over time. A recent study that is of high relevance to our case is Ambel et al [ 12 ]. They analyze child (and maternal) health inequalities using DHS data from 2000 to 2014.…”

Section: Introductionmentioning

confidence: 80%

“…The socioeconomic inequalities seem to increase from 2000 to 2011 for under-five and neonatal deaths, whereas they are stable or decreasing for the other indicators. More importantly, Ambel et al [ 12 ] analyze trends in child (and maternal) health inequalities by household wealth status, mothers’ education, and place of residence in Ethiopia. Using cross-sectional DHS data from 2000 to 2014, they compute concentration indices (CIs) in three undernutrition indicators (stunting, wasting and underweight) and show that widening pro-rich inequality.…”

Section: Literature Reviewmentioning

confidence: 99%

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Dynamics of inequality in child under-nutrition in Ethiopia

Negasi

2021

Int J Equity Health

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Introduction Although Ethiopia has already achieved a remarkable progress in reducing under-five mortality in the last decades, undernutrition among children is still a common problem in this country. Socioeconomic inequalities in health outcomes in Ethiopia have been thus of focus in academia and policy spheres for a while now. This study provides new evidence on child undernutrition inequalities in Ethiopia using longitudinal perspective. Method Using three round of household panel survey (from 2012 to 2016), we use concentration index (associated curve), different mobility index approaches for measuring inequalities and its dynamics, and decomposition method to identify contributing factors. Results In all concentration index computing approaches and socioeconomic status ranking variables, the concentration indices are significant with negative value. This implies that in either of short-run or long-run inequality estimates, the burden of unequal distribution of undernutrition remains on the poor with significant difference across regions. While employing different SES ranking variables, the difference in the concentration indices is only found significant in case of Height-for-age Z-score. It signifies that relatively higher inequality is measured using consumption as ranking variable. Significant difference in inequality is also shown across regions. With respect to dynamics of inequalities, results on mobility indices computed based on Allanson et al. (Longitudinal analysis of income-related health inequality. Dundee Discussion Working Paper No. 214, 2010) approach show that inequality remain stable (persistent) in Height-for- age Z-score, and reduction of inequality in Weight-for- age Z-score while in case of Weight-for- height Z-score, there is no clear trend over subsequent waves. Results on decomposition of inequalities show that the major contributors are wealth index, consumption and mother’s education. Conclusion The argument of the choice of welfare indicator can have a large and significant impact on measured socioeconomic inequalities in a health variable which it depends on the variable examined. Employing longitudinal perspective rather than weighted average of cross-sectional data is justifiable to see the dynamic of inequality in child malnutrition. In both socioeconomic status ranking variables, the bulk of inequality in malnutrition is caused by inequality in socioeconomic status in which it disfavours the poor in both cases. This calls for enhancing the policy measures that narrow socioeconomic gaps between groups in the population and targeting on early childhood intervention and nutrition sensitive.

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Maternal and Child Health Inequalities in Ethiopia

Cited by 9 publications

References 13 publications

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

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

Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian health sector

Dynamics of inequality in child under-nutrition in Ethiopia

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