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.
Int J Equity Health. 2017 May 16;16(1):82. doi: 10.1186/s12939-017-0579-x.
The 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.
Longitudinal 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.
From 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.
Skilled 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.
第五个千年发展目标（MDG）旨在改善孕产妇健康。在这方面，埃塞俄比亚在过去二十年中取得了重大进展。尽管如此，这些令人印象深刻的成就在不同社会经济特征的埃塞俄比亚妇女中分布不均。本研究旨在调查 2000 年至 2016 年期间熟练分娩服务的水平和趋势，以及财富和教育相关的不平等。
对埃塞俄比亚人口与健康调查（EDHS）2000 年、2005 年、2011 年和 2016 年的数据进行了纵向数据分析。因变量为熟练分娩，而经济状况和教育水平的数据则作为不平等的维度。应用了比率比（RR）和比率差（RD）不平等度量。使用 Windows 版本 10.1 的 STATA 统计软件进行数据分析和呈现。使用 95%置信区间评估不平等维度与因变量之间关联的强度。
在总分娩中，2000 年、2005 年、2011 年和 2016 年分别有 5.62%、6.3%、10.8%和 28%由熟练的分娩助手接生。在最近的调查（EDHS 2016）中，与没有正规教育的妇女相比，完成中学及以上教育的妇女接受熟练分娩助手接生的分娩比例约高 5.42 倍[95%置信区间（4.53，6.09）]。在最富有的五分之一中，由熟练的分娩助手接生的分娩比例约为最贫穷的五分之一的 5.11 倍[95%置信区间（3.98，6.12）]。此外，在最富有的五分之一和最贫穷的五分之一的妇女之间，以及在完成中学及以上教育的妇女和没有正规教育的妇女之间，接受熟练分娩服务的不平等差距从 2000 年的 24.2（2000 年）到 2016 年的 53.8（2016 年）百分比点大幅增加；从 2000 年的 44.9（2000 年）到 2016 年的 76.0（2016 年）百分比点增加。
2000-2011 年期间，熟练分娩的比例仍然很低且几乎没有变化，但在 2016 年大幅增加。财富和教育相关不平等的差距呈线性增长。最明显的不平等现象出现在妇女的教育水平上，这表明没有正规教育的妇女是最服务不足的群体。应该加强妇女在教育和经济发展计划中的参与，这是实现埃塞俄比亚可持续发展目标（SDG）全民健康覆盖（UHC）的努力的一部分。
