ArticleBMJ open2024
Socioeconomic inequality in postnatal care utilisation among reproductive age women in sub-Saharan African countries with high maternal mortality: a decomposition analysis.
Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Postnatal care service utilisation and associated factors among multiparous women in Buyamba County, Rakai District Uganda: a community-based cross-sectional study.Journal of health, population, and nutrition · 2025Article
- "It is because we women do not have a voice to be heard" - perceptions of gender-based discrimination and its relevance to health: a qualitative study with women in Burkina Faso, Ghana and Tanzania.International journal for equity in health · 2025Article
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4 authors.
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Abstract
objectiveTo assess the socioeconomic inequality in postnatal care (PNC) utilisation and its contributors among women in 14 sub-Saharan African countries with high maternal mortality.
designCommunity-based cross-sectional study using Demographic Health Survey
settingAfrica countries with the highest maternal mortality ratio (14 countries)
participantsAll women who had given birth within 2 years prior to the survey (n=64 912) PRIMARY OUTCOMES: Postnatal care utilisation
resultsThe percentage of women who had PNC utilisation was lowest in Ethiopia (23.4%: 95% CI: 22.1%, 24.7%) and highest in The Gambia (91.5%: 95% CI: 90.6%, 92.4%). There was statistically significant pro-rich inequality in the PNC utilisation in all countries except Liberia, meaning PNC utilisation was disproportionately concentrated among women from wealthier households. The weighted Erreygers Normalized Concentration Index (ECI) ranged from 0.0398 in The Gambia to 0.476 in Nigeria; the second-highest inequality was in Cameroon (0.382), followed by Guinea (0.344). The decomposition analysis revealed that the wealth index was the largest contributor to inequality in PNC utilisation in seven countries: Benin, Burundi, The Gambia, Guinea, Nigeria, Sierra Leone, Tanzania. In contrast, educational status emerged as the primary contibutor in Cameroon and Zimbabwe, media exposure in Mali and Mauritania, and distance to healthcare facilities in Ethiopia. However, in Liberia, the weighted ECI of 0.0012 with a p value of 0.96 indicate that there is no significant socioeconomic inequality in PNC utilisation, suggesting that the distribution of PNC utilisation is almost equal across different socioeconomic groups.
conclusionOur study revealed a pro-rich inequality in PNC utilisation across all included sub-Saharan African countries with high maternal mortality, except Liberia. This implies that PNC utilisation disproportionately favours the wealthy. Therefore, financially better-off women are more likely to utilise PNC services compared to those who are poor. Addressing the identified contributors of socioeconomic inequalities in PNC utilisation in each country remains crucial for achieving equity in PNC utilisation.
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