ArticleBMJ global health2021
Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Who cites it
31 citing papers in PubMed, 37 citations in OpenAlex.
- Who gets to deliver in a health facility? An investigation of wealth-based inequities in institutional delivery in Ghana.BMJ open · 2026Article
- Strengthening the hepatitis B care cascade to prevent vertical transmission in Africa: a call to empower midwives.BMJ global health · 2026Article
- Gender dynamics affecting women's uptake of maternal health service in agrarian and pastoral settings in Ethiopia: a community-based cross-sectional study.Reproductive health · 2026Article
- Woman-centred care in conflict-affected and fragile states: a scoping review of policy integration and implementation gaps in the greater horn of Africa.Reproductive health · 2026Article
- Article
- Prevalence and Determinants of Caesarean Section Deliveries in Ghana: A Population-Based Cross-sectional Study.Public health in practice (Oxford, England) · 2025Article
- Maternal mortality ratios in Southeast Asia (1990-2021): trends, disparities, and projections through 2050 based on the global burden of disease 2021, with reference to SDG 3.1.BMC pregnancy and childbirth · 2025Article
- Improving Decision-to-Incision Interval (DDI) of Emergency Cesarean Sections Through Mobile-Based Obstetric Emergency System (MORES) and Midwife-Led Triage in Bong County, Liberia: A Quasi-Experimental Study.International journal of environmental research and public health · 2025Article
- Effect of high-quality antenatal care on skilled birth attendant utilization in Ethiopia: a propensity score matching analysis.BMC health services research · 2025Article
- Inequality in Utilization of Maternal Healthcare Services in Low‑ and Middle‑Income Countries: A Scoping Review of the Literature.Maternal and child health journal · 2025Article
- Factors associated with quality of intrapartum care in Kenya: a complex samples analysis of the 2022 Kenya demographic and health survey.BMC pregnancy and childbirth · 2025Article
- Beyond physical accessibility, bypassing health facilities offering caesarean section: insights from women in Dakar's slums.BMJ open · 2025Article
- Determinants of non-use of antenatal care services in eastern Indonesia: analysis of the 2023 Indonesia health survey.Frontiers in global women's health · 2025Article
- Decomposing socioeconomic inequality in skilled birth attendant utilization in Ethiopia: A secondary data analysis.PloS one · 2025Article
- The shadow of violence: How intimate partner violence shapes contraceptive and maternal health service use across 25 African countries.PLOS global public health · 2025Article
- Gender disparities and barriers to access and use of essential health services in Ethiopia: Designing primary health care through gender lens.PLOS global public health · 2025Article
- Skilled birth attendance and its associated factors in Chad and Nigeria: A multilevel analysis of DHS data.PLOS global public health · 2025Article
- Assessing five-year trend and socio-demographic determinants of caesarean section delivery in Ghana.BMC pregnancy and childbirth · 2024Article
- Care-seeking for difficulties conceiving in sub-Saharan Africa: findings from population-based surveys in eight geographies.Human reproduction (Oxford, England) · 2024Article
- Spatial Access to Continuous Maternal and Perinatal Health Care Services in Low-Resource Settings: Cross-Sectional Study.JMIR public health and surveillance · 2024Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundImproved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa.
methodsWe analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section.
resultsThe rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant at birth was extremely high, with a difference of 46.2 percentage points between the poorest quintile (44.4%) and the richest quintile (90.6%). In 10 out of 25 countries, the caesarean section rate was less than 1% among the poorest quintile, but the rate was more than 15% among the richest quintile in nine countries. Four or more antenatal care contacts, improved maternal education, higher household wealth status and frequently listening to the radio increased the rates of having skilled attendant at birth and caesarean section. Women who reside in rural areas and those who have to travel long distances to access health facilities were less likely to have skilled attendant at birth or caesarean section.
conclusionsThere were significant within-country wealth-related inequalities in having skilled attendant at birth and caesarean delivery. Efforts to improve access to birth at the facility should begin in areas with low coverage and directly consider the needs and experiences of vulnerable populations.
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