Department of Statistics & Population Studies, University of the Western Cape, Cape Town, South Africa.
J Public Health (Oxf). 2020 May 26;42(2):254-261. doi: 10.1093/pubmed/fdz023.
Poor countries, such as Sierra Leone, often have poor health outcomes, whereby the majority of the population cannot access lifesaving health services. Access to, and use of, maternal and reproductive health services is crucial for human development, especially in developing regions. However, inequality remains a persistent problem for many developing countries. Moreover, we have not found empirical studies, which have examined inequalities in maternal and reproductive health in Sierra Leone.
We used data collected from the Sierra Leone Demographic and Health Surveys (DHS) conducted in 2008 and 2013. Five maternal and reproductive health indicators were selected for this study, including four or more antenatal care visits, skilled antenatal care provider, births delivered in a facility, births assisted by a skilled birth attendant, and any method of contraception. To measure inequalities, we adopted the Human Opportunity Index (HOI). Using this measure, we measured differentials over the two periods, and decomposed it to measure the contribution of the selected circumstance variables to inequality.
Inequalities declined over time, as shown by the decrease in the dissimilarity index. Due to the drop in the dissimilarity index, the HOI increased for all the selected maternal and reproductive health indicators. Moreover, antenatal services were closer to equality compared to the other selected services. Overall, we found that household wealth status, maternal education and place of residence, are the most important factors contributing to the inequality in the use of maternal and reproductive health services.
Even though there are improvements in inequalities over time, there are variations in the way in which inequality within the different indicators has improved. In order to improve the use of maternal and reproductive health services, and to reduce inequalities in these services, the government will have to invest in: (i) increasing the educational levels of women, (ii) improving the standard of living, as well as (iii) bringing maternal and reproductive health services closer to rural populations.
贫穷国家，如塞拉利昂，通常医疗服务质量较差，多数人无法获得救命的医疗服务。获取和使用孕产妇和生殖健康服务对人类发展至关重要，尤其是在发展中地区。然而，不平等仍然是许多发展中国家的一个长期问题。此外，我们尚未发现研究塞拉利昂孕产妇和生殖健康不平等的实证研究。
我们使用了 2008 年和 2013 年塞拉利昂人口与健康调查（DHS）收集的数据。本研究选择了四个孕产妇和生殖健康指标，包括四次或更多次产前检查、有熟练接生人员的产前护理、在医疗机构分娩、由熟练接生人员协助分娩和任何避孕方法。为了衡量不平等，我们采用了人类机会指数（HOI）。利用这一衡量标准，我们在两个时期衡量了差异，并将其分解以衡量所选环境变量对不平等的贡献。
不平等程度随时间下降，表现在不相似指数下降。由于不相似指数下降，所有选定的孕产妇和生殖健康指标的 HOI 都有所增加。此外，与其他选定的服务相比，产前服务更接近平等。总的来说，我们发现家庭财富状况、母亲教育程度和居住地是导致孕产妇和生殖健康服务利用不平等的最重要因素。
尽管不平等程度随时间有所改善，但不同指标内不平等程度的改善方式存在差异。为了改善孕产妇和生殖健康服务的利用，减少这些服务中的不平等，政府将不得不投资：（i）提高妇女的教育水平，（ii）提高生活水平，以及（iii）使孕产妇和生殖健康服务更接近农村人口。
