Measuring and explaining changing patterns of inequality in institutional deliveries between urban and rural women in Ghana: a decomposition analysis

Abstract

Background Despite recent progress in improving access to maternal health services, the utilization of these services remains inequitable among women in developing countries, and rural women are particularly disadvantaged. This study sought to measure i) disparities in the rates of institutional births between rural and urban women in Ghana, ii) the extent to which existing disparities are due to differences in the distribution of the determinants of institutional delivery between rural and urban women, and iii) the extent to which existing disparities are due to discrimination in resource availability. Methods Using Demographic and Health Survey data from 2003, 2008, and 2014, this study decomposed inequalities in institutional delivery rates among urban and rural Ghanaian woman using the Oaxaca, the Blinder, and related decompositions for non-linear models. The determinants of the observed inequalities were also analyzed. Results Institutional delivery rates in urban areas exceeded those of rural areas by 32.4 percentage points due to differences in distribution of the determinants of institutional delivery between the two areas. The main determinants driving the observed disparities were wealth, which contributed to about 16.1% of the gap, followed by education level, and number of antenatal visits. Conclusion Relative to urban women, rural women have lower rates of institutional deliveries due primarily to lower levels of wealth, which results in financial barriers in accessing maternal health services. Economic empowerment of rural women is crucial in order to close the gap in institutional delivery between urban and rural women.

Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis

“…This was also true for ANC follow up, presence of media access, single and grand parity. This finding is also supported by results in India [10] in Ghana [11] and in 80 low and middle-income countries study result [33]. In addition, husband secondary and higher education and age at childbirth were all important contributors to close the urban-rural gap of institutional delivery in Ethiopia.…”

“…There is considerable evidence that rural women gave home delivery compared to their urban counterparts [4,5,9,10]. For instance, decomposition analysis unfolded that urban residences in India and Ghana positively contributed to the facility delivery inequalities [10,11]. Another study conducted in Ethiopia [12][13][14], Guinea-Bissau [15], and Malawi [16] also showed similar findings.…”

“…Antenatal care visits attended (categorical variable with "none", and "one and above"), and parity (ordinal categorical variable representing the number of children born to a woman "1", "2 to 4" and "5 and above "). These classification was made based on previous literatures [11,12,16,17,23,25].…”

Socioeconomic inequality in short birth interval in Ethiopia: a decomposition analysis

“…Evidence from a crosscountry study performed in 18 Sub-Saharan countries has also revealed that wealth was the single most important driver of inequality in maternal healthcare utilization [60]. Prior studies [20,41,61,62] on related maternal health issues in Ethiopia and other developing countries also documented similar findings. Wealth status could affect birth interval of women through its effect on accessing family planning information and services.…”

Giving birth in Ethiopia: a spatial and multilevel analysis to determine availability and factors associated with healthcare facility births

“…47 Legally, maternal health services are free of charge in Ethiopia; 48 however, transportation and other opportunity costs, such as time spent on travel for the woman and accompanying families, are known to deter a woman's use of a health facility. 43,44,49 Interventions targeting poor women, such as maternity waiting homes, cash assistance, conditional cash transfer, and voucher and equity funds, are known to help increase the rate of facility births. 37,[50][51][52] A single-year increase in a woman's age at first childbirth was significantly associated with facility birth.…”