Inequalities in the Use Quality Antenatal Care and its Drivers: Further Analysis of the 2016 Ethiopia Demographic and Health Survey Data

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Addis Abeba University


Background: There is a growing body of evidence on the inequality in the use of maternal health care services. However, there is little evidence in the literature describing the status of inequality in use of quality of healthcare service. Particularly, there is a paucity of high-quality evidence on whether quality antenatal care (ANC) is being fairly distributed across the various subgroups of population in Ethiopia. This study aimed to examine the extent of inequalities in quality antenatal care and its drivers in Ethiopia using data from the most recent standard Ethiopia Demographic and Heath Survey. Methods: Cross sectional survey data from 2016 Ethiopia Demographic and Health Survey (EDHS) were used. The EDHS samples were selected through a stratified, two stage clustered sampling technique. To examine inequalities quality ANC was measured by using six WHO recommended ANC service elements. The inequality was assessed with respect to the selected equity stratifiers namely, region, place of residence, wealth quintile, maternal age and maternal education. We employed both the simple (ratio and difference) and complex (concentration index) measures of inequality. Further, wealth based inequality was decomposed to understand drivers under pinning the observed inequality. Result: The simple summary measure of inequality for the region showed high disparity across region with highest ANC quality (Addis Ababa region) and lowest (Afar region), difference (D)= 0.0690, 95% CI (0.0086, 0.1294) and the ratio ®=1.3844 with 95% CI (1.0227, 1.8946). Also showed maternal age based inequality with D=0.0864, 95% CI (0.0077, 0.1652) and R=1.4728, 95% CI (1.0328, 2.1004) value indicated that women aged above 20 while giving birth were more likely to have quality of ANC service. However, insignificant disparity was observed for place of residence difference (D) = 0.0298, 95% CI (0.0368, 0.0964) and ratio (R)=1.1368, 95% CI (0.8589, 1.5046). Concentration index for wealth and education based inequality was 0.15 and 0.21 respectively, indicating pro-rich and pro-educated scenario of the use of quality ANC. The decomposition analysis indicated that the main contributors of the wealth based inequality were region, wealth status, education, frequency of ANC visit, type of ANC facility and provider. Conclusion and recommendation: There were glaring inequalities in the receipt of quality ANC in Ethiopia. It needs high impact target interventions focused on region, wealth and frequencies of ANC were the main contributors together accounted for nearly three-fourth of the wealth driven inequality.



Quality, antenatal care, inequality, decomposition, DHS, Ethiopia