Disparities in maternal health services in sub-Saharan Africa
To examine the progress of and disparities in the provision of key maternal health services in the sub-Saharan Africa (SSA) region.
A time-trend analysis of disparities in antenatal care (ANC) and skilled birth attendance (SBA) coverage in SSA over the last 25 years was conducted. The average values of each country’s 5-year period data were used for analysis. Absolute and relative disparities were examined by time period, economic class, geographic group and clusters. Analysis of variance was used to compare progresses in coverage across time.
Regional median ANC coverage and SBA increased by 8% points and 15% points, respectively, during the 25-year period. The rank score of SBA has shown significant improvement only in the recent period. A 33.3% disparity between ANC and SBA was observed in the most recent period. The relative disparity by economic class and cluster was higher for SBA than ANC coverage.
The region showed improvement in both indicators across time. Regional disparity in ANC narrowed down while that of SBA remained high. These were mainly associated with economic class and cluster of countries.
KeywordsAntenatal care Skilled birth attendance Disparity Sub-Saharan Africa
Data for this study were downloaded from the freely accessed World Bank database. We extend our acknowledgement to the owner of the data. Our gratitude also goes to Associate professor Brian Phillips and Dr. Steve Price from Swinburne University for their technical help. Finally, we thank Swinburne University of Technology for all the support.
This study was funded by Swinburne University of Technology.
Compliance with ethical standards
This article does not contain any studies with human participants performed by any of the authors.
Conflict of interest
MAW declares that she has no conflict of interest. JB declares that he has no conflict of interest. JH declares that she has no conflict of interest. WB declares that he has no conflict of interest.
- Alkenbrack S, Chaitkin M, Zeng W et al (2015) Did equity of reproductive and maternal health service coverage increase during the MDG era? An analysis of trends and determinants across 74 low- and middle-income countries. PLoS One 10:e0134905. https://doi.org/10.1371/journal.pone.0134905 CrossRefPubMedPubMedCentralGoogle Scholar
- Braveman P (2006) Health disparities and health equity: concepts and measurement. Annu Rev Public Health 27:167–194. https://doi.org/10.1146/annurev.publhealth.27.021405.102103 CrossRefPubMedGoogle Scholar
- Center for Desease Control and Prevention (2011) Healthy People 2010: general data issues. https://www.cdc.gov/nchs/healthy_people/hp2010/hp2010_data_issues.htm. Accessed 06 Sep 2016
- Danso K (2007) International perspectives on health disparities and social justice: the African condition. Spring 17:50–54Google Scholar
- National Cancer Institute, US Department of Health and Human Service, National Institute of Health (2007) Selected comparisons of measures of health disparities using databases containing data relevant to Healthy People 2010 cancer-related goals, vol 07. NIH Publication, USAGoogle Scholar
- Health UDo, Services H (2000) Healthy people 2010: understanding and improving health. US Government Printing Office, Washington, DCGoogle Scholar
- Keppel K, Pamuk E, Lynch J et al. (2005) Methodological issues in measuring health disparities. Vital Health Stat Ser 2 Data Eval Methods Res (141):1–16Google Scholar
- Lewin S, Glenton C, Gulmezoglu A et al (2012) WHO recommendations. Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shiftingGoogle Scholar
- Lincetto O, Mothebesoane-Anoh S, Gomez P et al (2006) Antenatal care: opportunities for Africa's newborns. World Health Organization. http://www.who.int/pmnch/media/publications/aonsectionIII_2.pdf?ua=1. Accessed 10 Sep 2016
- Maine D (1991) Safe motherhood programs: options and issues. Columbia University, Center for Population and Family Health, New York CityGoogle Scholar
- Martin WE, Bridgmon KD (2012) Quantitative and statistical research methods: from hypothesis to results, vol 42. Wiley, HobokenGoogle Scholar
- National Partnership for Action (2011) Health equity & disparities. http://www.minorityhealth.hhs.gov/npa/templates/browse.aspx?lvl=1&lvlid=34. Accessed 8 Feb 2016
- Nordstokke DW, Zumbo BD (2010) A new nonparametric Levene test for equal variances. Psicológica: Revista de metodología y psicología experimental 31:401–430Google Scholar
- Pearson L, Larsson M, Fauveau V et al (2006) Childbirth care: opportunities for Africa's newborns. World Health Organization. http://www.who.int/pmnch/media/publications/aonsectionIII_3.pdf. Accessed 21 Aug 2016
- Sharan M, Ahmed S, Naimoli JF, Ghebrehiwet M, Rogo K (2010) Health system readiness to meet demand for obstetric care in Eritrea: implications for results-based financing (RBF). Working paper. World Bank, Washington, DCGoogle Scholar
- United Nations (2006) The millennium development goals report 2006. United Nations Department of Economic and Social Affairs, New YorkGoogle Scholar
- United Nations (2013) Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings. http://unstats.un.org/unsd/methods/m49/m49regin.htm#ftna. Accessed 20 Dec 2015
- United Nations (2014) The millennium development goals report 2014. United Nations Publications, New YorkGoogle Scholar
- United Nations (2015a) The millennium development goals report 2015. New YorkGoogle Scholar
- United Nations (2015b) Sustainable development goals. http://www.un.org/sustainabledevelopment/sustainable-development-goals/. Accessed 20 Oct 2016
- Villar J, Bergsjo P (2002) WHO antenatal care randomized trial: manual for the implementation of the new model. World Health Organization, GenevaGoogle Scholar
- World Bank (2015) World development indicators: sub-Saharan Africa. http://data.worldbank.org/region/SSA. Accessed 20 Sept 2015
- World Health Organization (1997) Coverage of maternity care: a listing of available information. Maternal and Newborn health/Safe motherhood, GenevaGoogle Scholar
- World Health Organization (2000) The world health report 2000—health systems: improving performance. World Health Organization, GenevaGoogle Scholar
- World Health Organization (2016) Selected policies for improving maternal and newborn healthGoogle Scholar
- World Health Organization (n.d.) Health indicators: the 11 indicators of maternal, newborn and child health. http://www.who.int/woman_child_accountability/progress_information/recommendation2/en/. Accessed 28 Mar 2016
- Zachary B, Moore Z, Govindasamy P (2013) Trends in demographic and reproductive health indicators in Ethiopia. ICF International Inc., Calverton, Maryland, USAGoogle Scholar