Twelve-year persistence of inequalities in antenatal care utilisation among women in Tanzania: a decomposition analysis of population-based cross-sectional surveys

Abstract

ObjectiveThis study was undertaken to assess the trend and contributors of socioeconomic inequalities in antenatal care (ANC) utilisation among women of reproductive age in Tanzania from 2004 to 2016.DesignPopulation-based cross-sectional surveys.SettingThis study analysed nationally representative data for women of reproductive age obtained from the 2004–2016 Tanzania Demographic Health Surveys.Primary outcome measureThe outcome variables analysed in this study are: (1) attendance of ANC and (2) accessing adequate antenatal care.Analytical methodsThe concentration curve and the concentration index were used to measure socioeconomic inequality in attending and accessing adequate ANC. The concentration index was decomposed to identify the factors explaining the observed socioeconomic inequality of these two outcomes.ResultsThe concentration index for attending at least four ANC visits increased from 0.169 in 2004 to 0.243 in 2016 (p<0.01). Similarly, for accessing adequate care, the index increased from 0.147 in 2004 to 0.355 in 2016 (p<0.01). This indicates the significant increase in socioeconomic inequalities (favouring wealthier women) for these two outcomes over time. Furthermore, the results show that wealth status was the largest contributor to inequality in both attending at least four visits (71%, 50% and 70%) and accessing adequate ANC (50%, 42% and 51%) in 2004, 2010 and 2016, respectively, in favour of wealthier women (p<0.05). The other contributors to socioeconomic inequalities in ANC utilisation were maternal education and type of residence.ConclusionOver the 12 years of surveys, there was no reduction in socioeconomic inequalities in ANC utilisation in Tanzania. Therefore, the efforts of achieving universal health coverage should focus on reducing wealth-related inequality and improving women’s education from poor households.

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

“…It's the poor who have the highest disease burden, reduced access to healthcare services and the majority do not utilize health services at all [89]. The pro-rich inequities have been observed before [30] and continue to be persist even among the poor pregnant women who are beneficiaries of government initiatives to improve ANC uptake [80,81,89]. Ensuring sufficient and timely reimbursements to prevent out-of-pocket payments and minimizing indirect costs of transport [75,76,90] will likely increase uptake among the poor ANC clients where initiatives already exist.…”

“…Recognizing that relying on broad, aggregate, and national-level estimates masks inherent spatial pockets of sub-national inequities, countries need to evaluate ANC4+ coverage along sub-groups [18,26] at high spatial resolution. Previous studies have examined ANC4+ coverage across sub-groups in Kenya, Uganda, and Tanzania [13,14,16,[27][28][29][30]. However, none of the earlier studies mapped ANC4+ coverage inequities per sub-group at high spatial granularity.…”

Socioeconomic determinants of antenatal healthcare inequalities in urban Pakistan

“…The second major contributor was wealth index. Interestingly, in other countries such as Tanzania, wealth was the major contributor (Bintabra and Basinda, 2021), the current study shows that wealth contributed to less than 17% of the inequality. However, it is imperative for the government to tackle this because in countries such as Pakistan, India, Nepal and Bangladesh, poverty is rampant (Islam et al.…”

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

“…It's the poor who have the highest disease burden, reduced access to healthcare services and the majority do not utilize health services at all (91). The pro-rich inequities have been observed before (30) and continue to be persist even among the poor pregnant women who are bene ciaries of government initiatives to improve ANC uptake (81, 82, 91).…”

“…Recognizing that relying on broad, aggregate, and national-level estimates masks inherent spatial pockets of sub-national inequities, countries need to evaluate ANC4 + coverage along sub-groups(18, 26) at high spatial resolution. Previous studies have examined ANC4 + coverage across sub-groups in Kenya, Uganda, and Tanzania (13,14,16,(27)(28)(29)(30). However, none of the earlier studies mapped ANC4 + coverage inequities per sub-group at high spatial granularity.…”