Denu Zewditu, Defar Atkure, Persson Lars, Lemma Seblewengel, Berhanu Della, Getachew Theodros, Shiferaw Solomon, Tariku Amare, Guadu Tadesse, Zelalem Meseret, Taye Girum, Schellenberg Joanna, Marchant Tanya, Alemu Kassahun
Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Health Serv Res. 2025 Apr 26;25(1):610. doi: 10.1186/s12913-025-12639-3.
Addressing disparities in reproductive, maternal, newborn, and child health services is crucial in achieving the Sustainable Development Goal of universal health coverage. The persistence of social and geographic disparities in maternal health service coverage and utilization poses significant challenges. Ensuring equity in health service access and utilization as part of universal health coverage requires evidence whether these inequities exist. This study aimed to measure socio-economic and geographic equity in coverage and effective coverage of both antenatal care and skilled birth attendance.
We conducted a secondary analysis of data collected from the Performance Monitoring for Action Ethiopia from 2019 to 2020, including 2714 postpartum women at around six weeks and service delivery point assessment data from 462 health facilities. We measured inequities in the utilization of four or more antenatal care visits and skilled birth attendance using equiplots and concentration index. Moran's I, Getis-Ord Gi statistics and Kriging interpolations were employed to analyze geographic variations of maternal health service utilization.
In this study, 40% (95%CI: 36, 45) utilized four or more ANC visits, and 12% (95%CI: 11, 14) received quality antenatal care. Over half (54%, 95%CI: 48, 59) of women utilized skilled birth attendance, but only 7% (95%CI: 4, 8) received quality delivery care. The absolute equity gap between the least poor and the poorest women was 43 percentage points for ANC visits and 65 percentage points for skilled birth attendance. A higher proportion of women in Central and Northern parts of Ethiopia had four or more ANC visits and utilized skilled birth attendance, while most parts of the Eastern part of the country and most areas in the South had low levels of utilization.
The coverage of four or more antenatal care visits and skilled birth attendance was low and inequitable, with the poorest women receiving fewer services. The coverage varied across different parts of the country. Interventions that target groups of women and geographic areas with low coverage of services are crucial for reaching the goal of universal health coverage.
解决生殖、孕产妇、新生儿和儿童健康服务方面的差距对于实现全民健康覆盖这一可持续发展目标至关重要。孕产妇健康服务覆盖范围和利用情况在社会和地理方面持续存在的差距带来了重大挑战。作为全民健康覆盖的一部分，确保健康服务获取和利用的公平性需要有证据证明这些不平等现象是否存在。本研究旨在衡量产前护理和熟练接生服务在覆盖范围和有效覆盖方面的社会经济和地理公平性。
我们对2019年至2020年从埃塞俄比亚行动绩效监测中收集的数据进行了二次分析，包括2714名产后约六周的妇女以及462个卫生设施的服务提供点评估数据。我们使用等值线图和集中指数来衡量四次或更多次产前护理就诊和熟练接生服务利用方面的不平等情况。采用莫兰指数、Getis-Ord Gi统计量和克里金插值法来分析孕产妇健康服务利用的地理差异。
在本研究中，40%（95%置信区间：36，45）的妇女进行了四次或更多次产前检查，12%（95%置信区间：11，14）接受了高质量的产前护理。超过一半（54%，95%置信区间：48，59）的妇女接受了熟练接生服务，但只有7%（95%置信区间：4，8）接受了高质量的分娩护理。最不贫困妇女和最贫困妇女在产前检查就诊方面的绝对公平差距为43个百分点，在熟练接生服务方面为65个百分点。埃塞俄比亚中部和北部地区有更高比例的妇女进行了四次或更多次产前检查并接受了熟练接生服务，而该国东部大部分地区和南部大部分地区的利用水平较低。
四次或更多次产前检查和熟练接生服务的覆盖范围较低且不公平，最贫困妇女获得的服务较少。覆盖范围在该国不同地区有所不同。针对服务覆盖范围低的妇女群体和地理区域的干预措施对于实现全民健康覆盖目标至关重要。
