International Journal of Public Health

, Volume 63, Issue 4, pp 525–535 | Cite as

Disparities in maternal health services in sub-Saharan Africa

  • Mulu Abraha Woldegiorgis
  • Janet E. Hiller
  • Wubegzier Mekonnen
  • Jahar Bhowmik
Original Article



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.


Antenatal 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

Ethical approval

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.

Supplementary material

38_2018_1086_MOESM1_ESM.pdf (327 kb)
Supplementary material 1 (PDF 327 kb)


  1. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  2. Amoakoh-Coleman M, Ansah EK, Agyepong IA et al (2015) Predictors of skilled attendance at delivery among antenatal clinic attendants in Ghana: a cross-sectional study of population data BMJ open 5:e007810PubMedGoogle Scholar
  3. Barros AJD, Ronsmans C, Axelson H et al (2012) Equity in maternal, newborn, and child health interventions in countdown to 2015: a retrospective review of survey data from 54 countries. Lancet 379:1225–1233CrossRefPubMedGoogle Scholar
  4. Braveman P (2006) Health disparities and health equity: concepts and measurement. Annu Rev Public Health 27:167–194. CrossRefPubMedGoogle Scholar
  5. Braveman P (2014) What are health disparities and health equity? We need to be clear. Public Health Rep 129:5–8CrossRefPubMedPubMedCentralGoogle Scholar
  6. Braveman P, Gruskin S (2003) Defining equity in health. J Epidemiol Community Health 57:254–258CrossRefPubMedPubMedCentralGoogle Scholar
  7. Center for Desease Control and Prevention (2011) Healthy People 2010: general data issues. Accessed 06 Sep 2016
  8. Danso K (2007) International perspectives on health disparities and social justice: the African condition. Spring 17:50–54Google Scholar
  9. Deller B, Tripathi V, Stender S et al (2015) Task shifting in maternal and newborn health care: key components from policy to implementation. Int J Gynecol Obstet 130(Supplement 2):S25–S31. CrossRefGoogle Scholar
  10. Evans T, Whitehead M, Diderichsen F et al (2001) Challenging inequities in health: from ethics to action. Oxford University Press, OxfordCrossRefGoogle Scholar
  11. Filippi V, Ronsmans C, Campbell OM et al (2006) Maternal health in poor countries: the broader context and a call for action. Lancet 368:1535–1541CrossRefPubMedGoogle Scholar
  12. 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
  13. Health UDo, Services H (2000) Healthy people 2010: understanding and improving health. US Government Printing Office, Washington, DCGoogle Scholar
  14. 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
  15. 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
  16. Lincetto O, Mothebesoane-Anoh S, Gomez P et al (2006) Antenatal care: opportunities for Africa's newborns. World Health Organization. Accessed 10 Sep 2016
  17. Mabey D, Gill G, Whitty CJ et al (2013) Principles of medicine in Africa. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  18. Maine D (1991) Safe motherhood programs: options and issues. Columbia University, Center for Population and Family Health, New York CityGoogle Scholar
  19. Marmot M (2005) Social determinants of health inequalities. Lancet 365:1099–1104. CrossRefPubMedGoogle Scholar
  20. Martin WE, Bridgmon KD (2012) Quantitative and statistical research methods: from hypothesis to results, vol 42. Wiley, HobokenGoogle Scholar
  21. Murray CJ, Gakidou EE, Frenk J (1999) Health inequalities and social group differences: what should we measure? Bull World Health Organ 77:537–543PubMedPubMedCentralGoogle Scholar
  22. Murtagh F, Legendre P (2014) Ward’s hierarchical agglomerative clustering method: which algorithms implement Ward’s criterion? J Classif 31:274–295CrossRefGoogle Scholar
  23. National Partnership for Action (2011) Health equity & disparities. Accessed 8 Feb 2016
  24. Nordstokke DW, Zumbo BD (2010) A new nonparametric Levene test for equal variances. Psicológica: Revista de metodología y psicología experimental 31:401–430Google Scholar
  25. Omran AR (2005) The epidemiologic transition: a theory of the epidemiology of population change. Milbank Q 83:731–757CrossRefPubMedPubMedCentralGoogle Scholar
  26. Pearcy JN, Keppel KG (2002) A summary measure of health disparity. Public Health Rep 117:273–280CrossRefPubMedPubMedCentralGoogle Scholar
  27. Pearson L, Larsson M, Fauveau V et al (2006) Childbirth care: opportunities for Africa's newborns. World Health Organization. Accessed 21 Aug 2016
  28. Prata N, Passano P, Rowen T et al (2011) Where there are (few) skilled birth attendants. J Health Popul Nutr 29:81–91CrossRefPubMedPubMedCentralGoogle Scholar
  29. 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
  30. Silal SP, Penn-Kekana L, Harris B et al (2012) Exploring inequalities in access to and use of maternal health services in South Africa. BMC Health Serv Res 12:120–131. CrossRefPubMedPubMedCentralGoogle Scholar
  31. Starrs AM (2006) Safe motherhood initiative: 20 years and counting. Lancet 368:1130–1132CrossRefPubMedGoogle Scholar
  32. United Nations (2006) The millennium development goals report 2006. United Nations Department of Economic and Social Affairs, New YorkGoogle Scholar
  33. United Nations (2013) Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings. Accessed 20 Dec 2015
  34. United Nations (2014) The millennium development goals report 2014. United Nations Publications, New YorkGoogle Scholar
  35. United Nations (2015a) The millennium development goals report 2015. New YorkGoogle Scholar
  36. United Nations (2015b) Sustainable development goals. Accessed 20 Oct 2016
  37. Villar J, Bergsjo P (2002) WHO antenatal care randomized trial: manual for the implementation of the new model. World Health Organization, GenevaGoogle Scholar
  38. World Bank (2015) World development indicators: sub-Saharan Africa. Accessed 20 Sept 2015
  39. World Health Organization (1997) Coverage of maternity care: a listing of available information. Maternal and Newborn health/Safe motherhood, GenevaGoogle Scholar
  40. World Health Organization (2000) The world health report 2000—health systems: improving performance. World Health Organization, GenevaGoogle Scholar
  41. World Health Organization (2016) Selected policies for improving maternal and newborn healthGoogle Scholar
  42. World Health Organization (n.d.) Health indicators: the 11 indicators of maternal, newborn and child health. Accessed 28 Mar 2016
  43. Zachary B, Moore Z, Govindasamy P (2013) Trends in demographic and reproductive health indicators in Ethiopia. ICF International Inc., Calverton, Maryland, USAGoogle Scholar

Copyright information

© Swiss School of Public Health (SSPH+) 2018

Authors and Affiliations

  • Mulu Abraha Woldegiorgis
    • 1
  • Janet E. Hiller
    • 1
    • 2
  • Wubegzier Mekonnen
    • 3
  • Jahar Bhowmik
    • 1
  1. 1.School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
  2. 2.School of Population HealthUniversity of AdelaideAdelaideAustralia
  3. 3.School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia

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