Access to mobile phone, socio-economic equity and maternal and child healthcare utilization in Rwanda: analysis of demographic and health surveys.

Abstract

Rwanda is harnessing digital health as a key strategy to improve optimal access to quality maternal and child health services, aiming to reduce maternal and child mortality and attain sustainable development goals. Evidence is essential to guide Rwanda's effort to integrate digital health technologies with maternal and child health service delivery. This study analyzed data from 2010, 2014/15 and 2019/20 Rwanda demographic and health surveys to explore trends and socio-economic equity in mobile phone ownership and its influence on reproductive and maternal health service utilization. Results showed a marked increase in household mobile phone ownership from 40% in 2010 to 71% in 2019/20. Significant pro-rich inequities in household mobile phone ownership were observed in 2010 (concentration index = 0.46), 2014/15 (concentration index = 0.28) and 2019/20 (concentration index = 0.22). Mobile phone was also higher among the educated in 2010 (slope index = 0.63), 2014/15 (slope index = 0.59), and 2019/20 (slope index = 0.50). Mobile phones were inequitably distributed favoring better-off (concentration index = 0.29) and educated women (slope index = 0.47), respectively. Women with mobile phone had significantly higher odds of attending four or more antenatal care visits [adjusted odds ratio (AOR) = 1.42, confidence interval (CI): 95% 1.16, 1.72] and ensuring full immunization in children aged 12-23 months [AOR = 1.61, CI: 95% 1.02, 2.55]. Differences in mobile phone ownership accounted 58% of the observed disparity in antenatal care utilization. These findings underscore that while there has been a substantial increase in mobile phone ownership, it remains unevenly distributed in Rwanda. Addressing these is critical to increasing coverage and equitable access to reproductive and maternal health services in Rwanda.