Inequities in the Uptake of Reproductive and Maternal Health Services in the Biggest Regional State of Ethiopia: Too Far from “Leaving No One Behind”
Received 28 July 2020
Accepted for publication 25 September 2020
Published 20 October 2020 Volume 2020:12 Pages 595—607
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Giorgio Lorenzo Colombo
Dawit Wolde Daka,1 Mirkuzie Woldie,1,2 Meskerem Seboka Ergiba,1 Birhanu Kenate Sori,3 Dereje Abdena Bayisa,3 Asfaw Benti Amente,3 Firew Tekle Bobo4,5
1Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia; 2Fenot Project, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia; 3Policy, Planning, Monitoring and Evaluation Directorate, Oromia Region Health Bureau, Addis Ababa, Ethiopia; 4Institute of Health Science, Department of Public Health, Wollega University, Nekemte, Ethiopia; 5School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
Correspondence: Dawit Wolde Daka
Jimma University, P.O. Box=378, Jimma, Ethiopia
Background: Despite improvement in the coverage of most maternal, newborn, and child health services, inequality in the uptake of services still remains the challenge of health systems in most developing countries. This study was conducted to examine the degree of inequities and potential predictors of inequity in reproductive and maternal health services utilization in the Oromia region, Ethiopia.
Methods: The 2016 Ethiopian demographic and health survey data set was used. Utilization rate of four maternal health service categories (family planning, antenatal care, facility based delivery and postnatal care) was considered in the analysis. Equity in each of these indicators was assessed by residence (urban/rural), wealth index, and educational status. Inequality in service utilization was estimated using rate ratios, concentration curve, and concentration indices.
Results: Overall data of 5701 women were used in this analysis. The concentration index to all of the maternal health service utilization indicators showed significance. The concentration index of family planning, antenatal care, facility based delivery, and postnatal care was 0.136 (95% CI=0.099– 0.173), 0.106 (95% CI=0.035– 0.177), 0.348 (95% CI=0.279– 0.418), and 0.348 (95% CI=0.279– 0.418), respectively. Maternal age and all of the three socio-demographic factors (residence, education, and wealth) showed inequitable distribution of maternal health service utilization in the Oromia region. The majority of women who were in the favored groups utilized the key reproductive and maternal health services.
Conclusion: The utilization of maternal health services in the study area is grossly skewed to those who are well off, educated, and live in urban areas. Any action intended to improve utilization of maternal and child health services should aim to reduce the unnecessary and avoidable disparity demonstrated in our analysis. This of course demands multisectoral intervention to impact on the determinants.
Keywords: inequity, reproductive health, maternal health, utilization, Oromia, Ethiopia
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