Inequities and their determinants in coverage of maternal health services in Burkina Faso

Abstract

BackgroundPoor and marginalized segments of society often display the worst health status due to limited access to health enhancing interventions. It follows that in order to enhance the health status of entire populations, inequities in access to health care services need to be addressed as an inherent element of any effort targeting Universal Health Coverage. In line with this observation and the need to generate evidence on the equity status quo in sub-Saharan Africa, we assessed the magnitude of the inequities and their determinants in coverage of maternal health services in Burkina Faso.MethodsWe assessed coverage for three basic maternal care services (at least four antenatal care visits, facility-based delivery, and at least one postnatal care visit) using data from a cross-sectional household survey including a total of 6655 mostly rural, poor women who had completed a pregnancy in the 24 months prior to the survey date. We assessed equity along the dimensions of household wealth, distance to the health facility, and literacy using both simple comparative measures and concentration indices. We also ran hierarchical random effects regression to confirm the presence or absence of inequities due to household wealth, distance, and literacy, while controlling for potential confounders.ResultsCoverage of facility based delivery was high (89%), but suboptimal for at least four antenatal care visits (44%) and one postnatal care visit (53%). We detected inequities along the dimensions of household wealth, literacy and distance. Service coverage was higher among the least poor, those who were literate, and those living closer to a health facility. We detected a significant positive association between household wealth and all outcome variables, and a positive association between literacy and facility-based delivery. We detected a negative association between living farther away from the catchment facility and all outcome variables.ConclusionExisting inequities in maternal health services in Burkina Faso are likely going to jeopardize the achievement of Universal Health Coverage. It is important that policy makers continue to strengthen and monitor the implementation of strategies that promote proportionate universalism and forge multi-sectoral approach in dealing with social determinants of inequities in maternal health services coverage.

Inequalities in reproductive health care use in five West-African countries: A decomposition analysis of the wealth-based gaps

“…We find that the number of children ever born by a woman, the cost of transportation and cost at the point of use are significant barriers that deter women from the appropriate use of antenatal care services. These are also consistent with findings from previous studies [8,15]. This is an indication that the abolishment of the user fee for maternal care services may contribute to wealth-based inequality in the use of these services.…”

“…A subpopulation study in Nigeria describing the free maternal health care intervention effect observes that the use of antenatal health care reduces with distance despite free maternal care policy [27]. Other studies clarify that money for health facility hinders women from profiting from the national maternal health care subsidy policy [15]. Another maternal characteristic, namely knowledge of pregnancy care, added to the disadvantage of poor women.…”

“…The socio-demographic covariates included were selected based on findings from previous empirical research on inequality and access to reproductive health care services [5,8,10,13,15,16]. For independent variable with more than 5% missing cases, we added a separate dummy variable indicating a missing value in the analysis.…”

“…This applies to the use of reproductive health care services as well. While several studies have shown that better-off women have easier access to reproductive health care [5,[7][8][9], other studies have demonstrated that socio-demographic factors such as marital status, education, occupation, residence typology, attitude of health workers, and distance to health facility also contribute to the inequality in the use reproductive health care among women [9][10][11][12][13][14][15][16]. In addition, it is unclear to what extent these determinants explain the use of reproductive health care and contribute to the differences between the groups [6,17].…”

The Utilization of Quality Antenatal Care in Pakistan: Analyzing Health Inequity in Various Periods

“…(Arsenault et al, 2018;Braveman, 2005;Harper et al, 2008;Zere et al, 2013). Secondly, it used a single indicator (skilled birth attendant) of quality antenatal care whereas previous studies used a variety of measures, such as the number of antenatal care visits, institutional delivery of a child, and the increase of tetanus injections (Gebre, Worku & Bukola, 2018;Hajizadeh et al, 2014;Majrooh et al, 2014;Mwase et al, 2018;Nair & Panda, 2011).…”