Socioeconomic inequities impacting complete continuum of maternal healthcare service utilisation over time in Ethiopia.

IF 1.7 4区经济学 Q3 BUSINESS, FINANCE

International Journal of Health Economics and Management Pub Date : 2025-08-23 DOI:10.1007/s10754-025-09401-x

Ayal Debie, Molla M Wassie, Annabelle Wilson, Claire T Roberts, Jacqueline H Stephens

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引用次数: 0

Abstract

Objective: To quantify socioeconomic inequities of complete continuity of maternal healthcare service over time using Ethiopian Demography and Health Survey data from 2011 to 2019.

Methods: A total of 10,768 women who had at least one antenatal care visit during their most recent childbirth were included for the analysis. Concentration index and concentration curve were used to assess wealth-based inequities. A generalized linear model with binomial distribution and a logit link function was used to decompose the Erreygers concentration index and measure each determinant's contribution.

Results: Complete continuum of maternal health service utilization in 2011, 2016, and 2019 among the wealthiest women were 25.9%, 33.7%, and 50.8%, respectively. In contrast, the corresponding continuum of maternal health service utilisation was 3.0%, 6.1%, and 11.2% among the lowest wealth categories. The Erreygers concentration indices of complete continuum of maternal health service utilization in 2011, 2016, and 2019 surveys were 0.203, 0.195, and 0.311, respectively, with the highest inequity observed in 2019. Concentration curves in each survey showed a pro-rich distribution of complete continuum of maternal health service utilisation. A unit percentage change in women's education, early initiation of antenatal care, being informed about pregnancy-related complications, and blood pressure monitoring during pregnancy increased their probability of completing continuum of maternal health service utilization. Specifically, a 1% increase in the proportion of secondary or higher education corresponded to a 0.02%, 0.01%, and 0.07% increase in the probability of completing continuum of maternal health service utilisation in 2011, 2016, and 2019, respectively. Conversely, in 2011, a 1% increase in the proportion of rural women and those with more than four parities led to a 0.11% and 0.05% decrease in the probability of completing continuum of maternal health service utilisation, respectively.

Conclusion: Complete continuum of maternal health service utilization was more likely amongst women without disadvantage, demonstrating wealth-based inequities in continuum of maternal health service utilization continue in Ethiopia. In this analysis, continuum of maternal health service utilisation remains inelastic across all surveys highlightsits the service is an essential form of care for women. Provision of maternal healthcare services targeting women from low household wealth status, residing in rural communities, and uneducated women must be prioritised by policymakers.

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随着时间的推移，社会经济不平等影响埃塞俄比亚孕产妇保健服务利用的完整连续性。

目的：利用2011年至2019年埃塞俄比亚人口与健康调查数据，量化孕产妇保健服务完全连续性的社会经济不平等。方法：共有10,768名在最近一次分娩期间至少进行过一次产前护理的妇女被纳入分析。集中度指数和集中度曲线被用来评估基于财富的不平等。采用二项分布的广义线性模型和logit链接函数对Erreygers浓度指数进行分解，并测量各行列式的贡献。结果：2011年、2016年和2019年，最富裕妇女的孕产妇保健服务利用率分别为25.9%、33.7%和50.8%。相比之下，在最低财富类别中，相应的孕产妇保健服务使用率分别为3.0%、6.1%和11.2%。2011年、2016年和2019年孕产妇保健服务利用完全连续性的Erreygers集中指数分别为0.203、0.195和0.311，不平等程度最高的年份为2019年。每次调查的集中曲线显示了产妇保健服务利用的完整连续体的亲富分布。妇女受教育程度、及早接受产前护理、了解与妊娠有关的并发症以及孕期血压监测等方面的单位百分比变化增加了她们完成连续使用孕产妇保健服务的可能性。具体而言，中等或高等教育比例每增加1%，分别在2011年、2016年和2019年完成连续的孕产妇保健服务利用的可能性增加0.02%、0.01%和0.07%。相反，2011年，农村妇女和生育四个以上胎次的妇女的比例每增加1%，分别导致完成连续使用孕产妇保健服务的可能性下降0.11%和0.05%。结论：没有不利条件的妇女更有可能完全连续地利用孕产妇保健服务，这表明在埃塞俄比亚，基于财富的不平等现象在持续利用孕产妇保健服务方面继续存在。在这一分析中，在所有调查中，孕产妇保健服务利用的连续性仍然没有弹性，这突出表明该服务是妇女保健的一种基本形式。决策者必须优先考虑为家庭财富地位低、居住在农村社区和未受过教育的妇女提供孕产妇保健服务。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Health Economics and Management Multiple-

CiteScore

3.60

自引率

0.00%

发文量

期刊介绍： The focus of the International Journal of Health Economics and Management is on health care systems and on the behavior of consumers, patients, and providers of such services. The links among management, public policy, payment, and performance are core topics of the relaunched journal. The demand for health care and its cost remain central concerns. Even as medical innovation allows providers to improve the lives of their patients, questions remain about how to efficiently deliver health care services, how to pay for it, and who should pay for it. These are central questions facing innovators, providers, and payers in the public and private sectors. One key to answering these questions is to understand how people choose among alternative arrangements, either in markets or through the political process. The choices made by healthcare managers concerning the organization and production of that care are also crucial. There is an important connection between the management of a health care system and its economic performance. The primary audience for this journal will be health economists and researchers in health management, along with the larger group of health services researchers. In addition, research and policy analysis reported in the journal should be of interest to health care providers, managers and policymakers, who need to know about the pressures facing insurers and governments, with consequences for regulation and mandates. The editors of the journal encourage submissions that analyze the behavior and interaction of the actors in health care, viz. consumers, providers, insurers, and governments. Preference will be given to contributions that combine theoretical with empirical work, evaluate conflicting findings, present new information, or compare experiences between countries and jurisdictions. In addition to conventional research articles, the journal will include specific subsections for shorter concise research findings and cont ributions to management and policy that provide important descriptive data or arguments about what policies follow from research findings. The composition of the editorial board is designed to cover the range of interest among economics and management researchers.Officially cited as: Int J Health Econ ManagFrom 2001 to 2014 the journal was published as International Journal of Health Care Finance and Economics. (Articles published in Vol. 1-14 officially cited as: Int J Health Care Finance Econ)