Socio-economic inequalities in access to maternal and child healthcare in Nigeria: changes over time and decomposition analysis

Adeyanju, Oludamilola; Tubeuf, Sandy; Ensor, Tim

doi:10.1093/heapol/czx049

Cited by 64 publications

(62 citation statements)

References 30 publications

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“…Therefore, in addition to the obstacle of studies, they mentioned other obstacles to the use of maternal health services. These include mothers' level of education, perception of care, lack of knowledge of obstetric complications and living in rural areas [10,11]. In addition, situations of political instability and armed conflict in a country compound the lack of access to maternal health services due to the deterioration of the health care system [12].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the use of maternal health services by mothers in a post-conflict area of western Côte d’Ivoire in 2016

Samba

Attia-Konan

Sangaré

et al. 2020

BMC Health Serv Res

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Background: In Côte d'Ivoire, maternal health service utilization indicators remain low despite improvements in health coverage and the availability of free health care for pregnant women. The objective of the study was to identify the determinants associated with the use of maternal health services in the department of Bloléquin, in western Côte d'Ivoire. Methods: We conducted a cross-sectional study with an analytical focus. The study sample size was 400 women. Study participants were selected through a two-stage cluster survey. The data were collected using a standardized questionnaire whose items concerned socio-demographic data, the different uses of maternal health services, namely childbirth assisted by a health professional, use of family planning, prenatal consultation and postnatal consultation. Logistic regression was used to investigate factors associated with the use of maternal health services. The significance of the statistical tests was set at 5%. The odds ratios and 95% confidence intervals were calculated and interpreted. Results: The results showed that women made less use of family planning services (OR = 0.4), prenatal consultation (OR = 0.2) and assisted childbirth (OR = 0.2) when they provided the funding for care themselves. Women with monthly incomes above $26.8 used family planning services 4 times more than those with lower incomes. Married women used prenatal consultations 3 times more often than unmarried women (CI 95% = 1.4-7.3). Desiring pregnancy increased the use of post-natal consultations by 3 times (CI 95% = 1.5-6.1). Conclusion: Improving the use of maternal health services in western Côte d'Ivoire requires taking into account women's socio-cultural and economic challenges. In initiatives related to the financial empowerment of women, efforts must be made at the level of emotional considerations related to pregnancy.

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Section: Discussionmentioning

confidence: 99%

Factors associated with the use of maternal health services by mothers in a post-conflict area of western Côte d’Ivoire in 2016

Samba

Attia-Konan

Sangaré

et al. 2020

BMC Health Serv Res

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“…Notably, more women in Ethiopia and Uttar Pradesh had access to maternity care in 2015 than in 2012; however, this was not the case in Gombe State, where sociocultural barriers to access persisted, and the Boko Haram insurgency presented a barrier to accessing care. 23 In all 3 settings, coverage for early postnatal care remained low, despite strong government commitment to and intense nongovernment effort for community-based programming. Improving outcomes for mothers and newborns requires not only structural changes in the provision of care, but also behaviour change by individuals, communities and health care providers.…”

Section: Discussionmentioning

confidence: 99%

“…In 2012, coverage levels were all about 50% or above, with the exception of at least 4 antenatal visits (28% [170/604]; 95% CI 24%-33%) and postnatal care for the newborn (19% [114/604]; 95% CI 15%-23%); these 2 indicators still had the lowest coverage in 2015 ( Table 6). Evidence of inequity in relation to socioeconomic status was present in 2012 for antenatal care (p < 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) 28 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) Note: CI = confidence interval, NA = not applicable, OR = odds ratio, SES = socioeconomic status. *The p value for OR for difference in coverage over time.…”

Section: Six Districts Of Uttar Pradesh Indiamentioning

confidence: 99%

Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India

Marchant

Beaumont

Makowiecka

et al. 2019

CMAJ

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BACKGROUND: Despite progress toward meeting the Sustainable Development Goals, a large burden of maternal and neonatal mortality persists for the most vulnerable people in rural areas. We assessed coverage, coverage change and inequity for 8 maternal and newborn health care indicators in parts of rural Nigeria, Ethiopia and India. METHODS: We examined coverage changes and inequity in 2012 and 2015 in 3 high-burden populations where multiple actors were attempting to improve outcomes. We conducted cluster-based household surveys using a structured questionnaire to collect 8 priority indicators, disaggregated by relative household socioeconomic status. Where there was evidence of a change in coverage between 2012 and 2015, we used binomial regression models to assess whether the change reduced inequity. RESULTS: In 2015, we interviewed women with a birth in the previous 12 months in Gombe, Nigeria (n = 1100 women), Ethiopia (n = 404) and Uttar Pradesh, India (n = 584). Among the 8 indicators, 2 positive coverage changes were observed in each of Gombe and Uttar Pradesh, and 5 in Ethiopia. Coverage improvements occurred equally for all socioeconomic groups, with little improvement in inequity. For example, in Ethiopia, coverage of facility delivery almost tripled, increasing from 15% (95% confidence interval [CI] 9%-25%) to 43% (95% CI 33%-54%). This change was similar across socioeconomic groups (p = 0.2). By 2015, the poorest women had about the same facility delivery coverage as the least poor women had had in 2012 (32% and 36%, respectively), but coverage for the least poor had increased to 60%. INTERPRETATION: Although coverage increased equitably because of various community-based interventions, underlying inequities persisted. Action is needed to address the needs of the most vulnerable women, particularly those living in the most rural areas.

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“…The socio-demographic covariates included were selected based on findings from previous empirical research on inequality and access to reproductive health care services [5,8,10,13,15,16]. For independent variable with more than 5% missing cases, we added a separate dummy variable indicating a missing value in the analysis.…”

Section: Variablesmentioning

confidence: 99%

“…This applies to the use of reproductive health care services as well. While several studies have shown that better-off women have easier access to reproductive health care [5,[7][8][9], other studies have demonstrated that socio-demographic factors such as marital status, education, occupation, residence typology, attitude of health workers, and distance to health facility also contribute to the inequality in the use reproductive health care among women [9][10][11][12][13][14][15][16]. In addition, it is unclear to what extent these determinants explain the use of reproductive health care and contribute to the differences between the groups [6,17].…”

Section: Introductionmentioning

confidence: 99%

Inequalities in reproductive health care use in five West-African countries: A decomposition analysis of the wealth-based gaps

Ogundele

Pavlova

Groot

2020

Int J Equity Health

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Background: Family 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. Methods: Using 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. Results: Our 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. Conclusions: There 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.

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Socio-economic inequalities in access to maternal and child healthcare in Nigeria: changes over time and decomposition analysis

Cited by 64 publications

References 30 publications

Factors associated with the use of maternal health services by mothers in a post-conflict area of western Côte d’Ivoire in 2016

Factors associated with the use of maternal health services by mothers in a post-conflict area of western Côte d’Ivoire in 2016

Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India

Inequalities in reproductive health care use in five West-African countries: A decomposition analysis of the wealth-based gaps

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