Equity in Access to Quality Maternal and Child Health Services in sub-Saharan Africa
- Publication Type:
- Thesis
- Issue Date:
- 2022
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𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Monitoring and addressing inequalities in quality of maternal and child health services is a priority global health agenda. The aim of this study was to assess the status of equity in access to quality maternal and child health services in sub-Saharan Africa.
𝗠𝗲𝘁𝗵𝗼𝗱𝘀: This analysis examined the sub-Saharan African countries with the latest Demographic and Health Surveys (DHS) conducted between 2013 and 2020. The study examined socioeconomic inequalities using three equity analysis methods: rate/ratio, concentration curve, and concentration index. A multilevel modelling (generalised linear latent and mixed models) was used to explain inequities in access to quality maternal and child health services. Decomposition analysis was also employed to explain wealth-related disparities in vaccination coverage.
𝗥𝗲𝘀𝘂𝗹𝘁𝘀: The findings showed a substantial gap between the contact and content of antenatal care that women received during visits. Coverage of skilled birth attendance and caesarean section showed substantial inequalities favouring women from wealthier households across all countries. Evaluations of maternal health services along the continuum of care showed high dropout rates and increasing inequalities across sub-Saharan African countries. The study also revealed that children from low-income households were disproportionately affected by zero-dose vaccination, while children from wealthier households had higher rates of full vaccination coverage. The findings also highlighted that inequalities in maternal health and child vaccination were influenced by factors such as wealth, education, access to media, place of residence, age, and parity. Women and children residing in rural areas and those travelling long distances to access health facilities were less likely to use maternal and child health services.
𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻𝘀: Despite efforts towards improving maternal and child health coverage, progress has been insufficient at both the national level and across equity dimensions, hindering progress towards universal health coverage. Regular assessments of health inequality can be used as a warning system and diagnostic tool to identify and address those in need. To improve access to maternal and child health services, it is crucial to initiate efforts in areas with poor coverage while also considering the specific needs and experiences of vulnerable populations.
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