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

Abstract

Background Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. Methods The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). Results The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. Conclusions The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women’s income, access to health care facilities to increase the frequency of antenatal care utilization.

Area of focus to handle delays related to maternal death in Ethiopia

“…Besides women who live in rural areas have shown a lower risk of encountering delays two and three compared with their counterparts who live in urban areas. The finding was comparable with studies done elsewhere [24,[82][83][84], which revealed the presence of inequality in maternal service utilization based on residence and region. The likely explanation for this could be the fact that women who reside in rural areas and pastoralist regions have limited information on maternity services; in addition, this could also be due to the challenge residents face in accessing health facilities within a reasonable distance and time.…”

Prevalence and determinants of home delivery in urban and rural Philippines: Evidence from the 2017 National Demographic and Health Survey

“…More importantly, delivering at home could delay life-saving treatment should complications due to childbirth occur. 8 Compared to similar studies in the African region, 28 – 30 we found wealth index had the most pronounced effect on both urban and rural estimates although there is consistency in the finding that more rural women deliver at home. This may be driven by income differences with use of maternal and child health services favoring the rich despite subsidies.…”

“…Urban-rural estimates on place of delivery have been published using data from the African region and have shown that there are notable differences in the uptake of skilled delivery services in urban and rural communities. [28][29][30] Such studies are especially important with the ongoing COVID-19 pandemic overwhelming the health system and further discouraging women to seek health care and services in health facilities. Because women are often disproportionately affected during disasters, further strengthening the health facilities across the country and integrating in the pandemic response strategies for women to birth safely will be critical to advancing progress to reduce maternal mortality.…”

Impacts of COVID-19 on reproductive health service provision, access, and utilization in Ethiopia: Results from a qualitative study with service users, providers, and stakeholders

“…Prior to COVID-19, urban-rural disparities in access to SRH services in Ethiopia were well-documented [ 39 , 40 ]. We found that geographic barriers to access became more pronounced during the pandemic, particularly due to limited and costly transportation options, and inequities in availability of both COVID-19 and SRH services.…”