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other·epidemiology, public health, obstetrics and gynecology, observational study·PMC10138853

Decomposition analysis of women’s empowerment-based inequalities in the use of maternal health care services in Ethiopia: Evidence from Demographic and Health Surveys

PLOS ONE · 6 authors, 3 centres

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TL;DR

This study analyzed Ethiopian Demographic and Health Survey data from 2000 to 2016 to assess inequalities in maternal health care service use based on women's empowerment. It found that service utilization was inequitably distributed, with more empowered women having significantly higher use of services like antenatal and postnatal care.

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Analysis employed concentration indices and decomposition methods. Results showed service utilization was inequitably distributed, favoring highly empowered women, with Erreygers indices for quality ANC ranging from 0.122 to 0.240 across empowerment domains. Inequalities were primarily driven by underlying disparities in wealth, education, place of residence, and the empowerment domains themselves.

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other

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epidemiology

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ORIGINAL PAPER

PMC10138853

Decomposition analysis of women’s empowerment-based inequalities in the use of maternal health care services in Ethiopia: Evidence from Demographic and Health Surveys

PLOS ONE

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ABSTRACT

Abstract Background The use of maternal health care services tends to rise with women’s empowerment. However, disparities in the use of maternal health care services in Ethiopia that are founded on women’s empowerment are not sufficiently addressed. In light of women’s empowerment equity stratifier, this study seeks to assess inequalities in the uptake of maternal health care services (early antenatal care, four or more antenatal care and postnatal care services). Methods Drawing on data from the four rounds of Ethiopia Demographic and Health Surveys (EDHSs) conducted between 2000 and 2016, we conducted analysis of inequalities in utilization of maternal health care services using women’s empowerment as equity stratifier. We utilized concentration index and concentration curve for assessing the inequalities. We used clorenz and conindex Stata modules to compute the index and curve. Decomposition of the Erreygers normalized concentration index was done to explain the inequalities in terms of other variables’ percent contributions. Complex aspect of the EDHSs data was considered during analysis to produce findings consistent with the data generating process. All analyses were done using Stata v16. Results Utilization of maternal health care services was inequitably distributed between empowered and poorly empowered women, with women in the highly empowered category taking more of the services. For instance, the Erreygers index for quality ANC are 0.240 (95% CI 0.207, 0.273); 0.20 (95% CI 0.169, 0.231) and 0.122 (95% CI 0.087, 0.157), respectively, for the attitude towards violence, social independence and decision-making domains of women’s empowerment. Inequalities in the distribution of other variables like wealth, education, place of residence and women’s empowerment itself underpin the inequalities in the utilization of the services across the women’s empowerment groups. Conclusions Equity in maternal health care services can be improved through redistributive policies that attempt to fairly distribute the socioeconomic determinants of health such as wealth and education between highly and poorly empowered women.

CITATION EXPORT

Gebretsadik Shibre, Wubegzier Mekonnen, Damen Haile Mariam et al.. Decomposition analysis of women’s empowerment-based inequalities in the use of maternal health care services in Ethiopia: Evidence from Demographic and Health Surveys. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0285024

AUTHORS

6 · 3 CENTRES

Gebretsadik Shibre, Wubegzier Mekonnen, Damen Haile Mariam, Kannan Navaneetham, Kannan Navaneetham, Kannan Navaneetham

1Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
2Department of Health system and Policy, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
3University of Botswana, BOTSWANA