Skilled delivery inequality in Ethiopia: to what extent are the poorest and uneducated mothers benefiting?

International Journal for Equity in Health

Research

Mihiretu Kebede¹  Brook Tesfaye²  Tsedeke Mathewos³ 

[1] Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia;Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstraße 30, Bremen, Germany;University of Bremen, Health Sciences, Bremen, Germany;Health Policy and Planning Directorate, Ethiopian Federal Ministry of Health, Sudan Street, Lideta Sub-city, Addis Ababa, Ethiopia;John Snow Incorporated Research and Training Institute, Health Management Information System Scale-up Project, Addis Ababa, Ethiopia;Technical Assistant to Director of Health Policy and Planning Directorate, Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia;

关键词: Equity;    Inequality;    Maternal health;    Maternal Mortality Ratio (MMR);    Universal Health Coverage (UHC);    Sustainable Development Goals (SDGs);    Developing country;    Ethiopia;   

DOI  :  10.1186/s12939-017-0579-x

 received in 2016-12-27, accepted in 2017-05-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe fifth Millennium Development Goal (MDG) targeted at improving maternal health. In this regard, Ethiopia has shown substantial progresses in the past two decades. Nonetheless, these impressive gains are unevenly distributed among Ethiopian women with different socio-economic characteristics. This study aimed at investigating levels and trends of skilled delivery service, and wealth and education related inequalities from 2000 to 16.MethodsLongitudinal data analysis was conducted on Ethiopian Demographic and Health Survey (EDHS) data of 2000, 2005, 2011 and 2016. The outcome variable was skilled delivery, while data on economic status and education level were used as dimensions of inequality. Rate Ratio (RR) and Rate Difference (RD) inequality measures were applied. STATA for windows version 10.1 statistical software was utilized for data analysis and presentation. The strength of association of inequality dimensions with the outcome variable was assessed using a 95% confidence interval.ResultsFrom total deliveries, 5.62%, 6.3%, 10.8% and 28% of them were attended by skilled birth attendant in 2000, 2005, 2011 and 2016 respectively. In the most recent survey (EDHS 2016), proportion of births attended by skilled birth attendance among women who completed secondary and above education was about 5.42 [95% CI (4.53, 6.09)] times more when compared to women with no formal education. Proportion of births attended by skilled birth attendance among women in the richest quintile was about 5.11 [95% CI (3.98, 6.12)] times higher than that of women in the poorest quintile. Moreover, gap of inequality on receiving skilled delivery service has increased substantially from 24.2 (2000) to 53.8 (2016) percentage points between women in the richest and poorest quintiles; and from 44.9 (2000) to 76.0 (2016) percentage points between women who completed secondary and above education and women with no formal education.ConclusionsSkilled birth attendance remained low and virtually unchanged during the period 2000–2011, but increased substantially in 2016. Gap on wealth and education related inequalities increased linearly during 2000–16. Most pronounced inequalities were observed in women’s level of education revealing women with no formal education were the most underserved subgroups. Encouraging women in education and economic development programs should be strengthened as part of the effort to attain Universal Health Coverage (UHC) of Sustainable Development Goals (SDGs) in Ethiopia.

【 授权许可】

CC BY   
© The Author(s). 2017