Poor coverage and quality for poor women: Inequalities in quality antenatal in nine East African countries

Bobo, FT; Asante, A; Woldie, M; Hayen, A

Poor coverage and quality for poor women: Inequalities in quality antenatal in nine East African countries

Bobo, FT Asante, A Woldie, M Hayen, A

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Publisher:: Oxford University Press
Publication Type:: Journal Article
Citation:: Health Policy and Planning, 2021, 36, (5), pp. 662-672
Issue Date:: 2021-04-05

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Field	Value	Language
dc.contributor.author	Bobo, FT
dc.contributor.author	Asante, A
dc.contributor.author	Woldie, M
dc.contributor.author	Hayen, A https://orcid.org/0000-0003-4046-8030
dc.date.accessioned	2022-01-06T05:07:25Z
dc.date.available	2020-12-07
dc.date.available	2022-01-06T05:07:25Z
dc.date.issued	2021-04-05
dc.identifier.citation	Health Policy and Planning, 2021, 36, (5), pp. 662-672
dc.identifier.issn	0268-1080
dc.identifier.issn	1460-2237
dc.identifier.uri	http://hdl.handle.net/10453/152750
dc.description.abstract	The use of quality antenatal care (ANC) improves maternal and newborn health outcomes. Ensuring equity in access to quality maternal health services is a priority agenda in low- and middle-income countries. This study aimed to assess inequalities in the use of quality ANC in nine East African countries using the most recent Demographic and Health Surveys. We used two outcome variables to examine ANC service adequacy: four or more ANC contacts and quality ANC. We defined quality ANC as having six of the recommended ANC components during follow-up: blood pressure measurement, urine sample test, blood sample test, provision of iron supplements, drug for intestinal parasite and tetanus toxoid injections. We used the concentration index (CCI) to examine inequalities within and across countries. We fitted a multilevel regression model to assess the predictors of inequalities in the contact and content of ANC. This study included 87 068 women; among those 54.4% (n = 47 387) had four or more ANC contacts, but only 21% (n = 15 759) reported receiving all six services. The coverage of four or more ANC and receipt of all six services was pro-rich within and across all countries. The highest inequality in four or more ANC contacts was in Ethiopia with a CCI of 0.209, while women in Burundi had the highest inequality in coverage of all six services (CCI: 0.318). Higher education levels and media exposure were predictors of service uptake, while women who had unintended pregnancies were less likely to make four or more ANC contacts and receive six services. Interventions to improve access to quality ANC require rethinking the service delivery mechanisms in all countries. Moreover, ensuring equity in access to quality ANC requires tailoring service delivery modalities to address the social determinants of service uptake.
dc.format	Print
dc.language	eng
dc.publisher	Oxford University Press
dc.relation.ispartof	Health Policy and Planning
dc.relation.isbasedon	10.1093/heapol/czaa192
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1605 Policy and Administration, 1606 Political Science
dc.subject.classification	Health Policy & Services
dc.subject.mesh	Africa, Eastern
dc.subject.mesh	Burundi
dc.subject.mesh	Ethiopia
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Pregnancy
dc.subject.mesh	Prenatal Care
dc.subject.mesh	Socioeconomic Factors
dc.subject.mesh	Humans
dc.subject.mesh	Prenatal Care
dc.subject.mesh	Pregnancy
dc.subject.mesh	Socioeconomic Factors
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	Maternal Health Services
dc.subject.mesh	Africa, Eastern
dc.subject.mesh	Burundi
dc.subject.mesh	Ethiopia
dc.subject.mesh	Female
dc.title	Poor coverage and quality for poor women: Inequalities in quality antenatal in nine East African countries
dc.type	Journal Article
utslib.citation.volume	36
utslib.location.activity	England
utslib.for	1117 Public Health and Health Services
utslib.for	1605 Policy and Administration
utslib.for	1606 Political Science
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-01-06T05:07:23Z
pubs.issue	5
pubs.publication-status	Published
pubs.volume	36
utslib.citation.issue	5

Abstract:

The use of quality antenatal care (ANC) improves maternal and newborn health outcomes. Ensuring equity in access to quality maternal health services is a priority agenda in low- and middle-income countries. This study aimed to assess inequalities in the use of quality ANC in nine East African countries using the most recent Demographic and Health Surveys. We used two outcome variables to examine ANC service adequacy: four or more ANC contacts and quality ANC. We defined quality ANC as having six of the recommended ANC components during follow-up: blood pressure measurement, urine sample test, blood sample test, provision of iron supplements, drug for intestinal parasite and tetanus toxoid injections. We used the concentration index (CCI) to examine inequalities within and across countries. We fitted a multilevel regression model to assess the predictors of inequalities in the contact and content of ANC. This study included 87 068 women; among those 54.4% (n = 47 387) had four or more ANC contacts, but only 21% (n = 15 759) reported receiving all six services. The coverage of four or more ANC and receipt of all six services was pro-rich within and across all countries. The highest inequality in four or more ANC contacts was in Ethiopia with a CCI of 0.209, while women in Burundi had the highest inequality in coverage of all six services (CCI: 0.318). Higher education levels and media exposure were predictors of service uptake, while women who had unintended pregnancies were less likely to make four or more ANC contacts and receive six services. Interventions to improve access to quality ANC require rethinking the service delivery mechanisms in all countries. Moreover, ensuring equity in access to quality ANC requires tailoring service delivery modalities to address the social determinants of service uptake.

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http://hdl.handle.net/10453/152750