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Cited by 57Healthcare Systems and ReformsPublic Health and Social InequalitiesGlobal Maternal and Child Health

Socioeconomic inequality in barriers for accessing health care among married reproductive aged women in sub-Saharan African countries: a decomposition analysis

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Alamneh, Tesfa Sewunet, Teshale, Achamyeleh Birhanu, Yeshaw, Yigizie, Alem, Adugnaw Zeleke, Ayalew, Hiwotie Getaneh, Liyew, Alemneh Mekuriaw, Tessema, Zemenu Tadesse, Tesema, Getayeneh Antehunegn, Worku, Misganaw Gebrie·2022·BMC Women's Health
DOI 10.1186/s12905-022-01716-yPMC PMC9036791
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Abstract

BACKGROUND: Accessibility of health care is an essential for promoting healthy life, preventing diseases and deaths, and enhancing health equity for all. Barriers in accessing health care among reproductive-age women creates the first and the third delay for maternal mortality and leads to the occurrence of preventable complications related to pregnancy and childbirth. Studies revealed that barriers for accessing health care are concentrated among individuals with poor socioeconomic status which creates health inequality despite many international organizations top priority is enhancing universal health coverage. Therefore, this study aimed to assess the presence of socioeconomic inequality in barriers for accessing health care and its contributors in Sub-Saharan African countries. METHODS: The most recent DHS data of 33 sub-Saharan African countries from 2010 to 2020 were used. A total sample of 278,501 married reproductive aged were included in the study. Erreygers normalized concentration index (ECI) and its concentration curve were used while assessing the socioeconomic-related inequality in barriers for accessing health care. A decomposition analysis was performed to identify factors contributing for the socioeconomic-related inequality. RESULTS: The weighted Erreygers normalized Concentration Index (ECI) for barriers in accessing health care was - 0.289 with Standard error = 0.005 (P value < 0.0001); indicating that barriers in accessing health care was disproportionately concentrated among the poor. The decomposition analysis revealed that wealth index (42.58%), place of residency (36.42%), husband educational level (5.98%), women educational level (6.34%), and mass media exposure (3.07%) were the major contributors for the pro-poor socioeconomic inequalities in barriers for accessing health care. CONCLUSION: In this study, there is a pro-poor inequality in barriers for accessing health care. There is a need to intensify programs that improve wealth status, education level of the population, and mass media coverage to tackle the barriers for accessing health care among the poor.

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  • Reproductive-age women in urban areas reported the least financial barriers to access healthcare compared to their counterparts in rural areas.

    “Additionally, reproductive-age women in urban areas reported the least financial barriers to access healthcare compared to their counterpart in rural areas”

    From Financial barriers to healthcare access among reproductive-age women in Sierra Leone: evidence from demographic health surveys of 2008, 2013, and 2019 (2026) · cites this paper as [1]

    Table 2 in the Results reports fewer overall healthcare-access barriers among urban than rural married women in sub-Saharan Africa (49.97% versus 70.90%). The Methods define that outcome as a composite of four barriers, including obtaining money; the paper does not report an urban–rural comparison for financial barriers specifically. (LLM, conf=0.88)

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  1. [5]Makinen M Waters H Rauch M Almagambetova N Bitrán R Gilson L Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition Bull World Health Organ 2000 78 55 65 10686733 PMC2560608
  2. [6]Novignon J Ofori B Tabiri KG Pulok MH Socioeconomic inequalities in maternal health care utilization in Ghana Int J Equity Health 2019 18 1 1 11 10.1186/s12939-019-1043-x 31488160 PMC6729067 · DOI
  3. [7]Gulliford M Figueroa-Munoz J Morgan M Hughes D Gibson B Beech R What does ‘access to health care’ mean? J Health Serv Res Policy 2002 7 3 186 188 10.1258/135581902760082517 12171751 · DOI
  4. [8]Munthali AC Swartz L Mannan H MacLachlan M Chilimampunga C Makupe C “This one will delay us”: barriers to accessing health care services among persons with disabilities in Malawi Disabil Rehabil 2019 41 6 683 690 10.1080/09638288.2017.1404148 29172751 · DOI
  5. [9]Rutherford ME Mulholland K Hill PC How access to health care relates to under-five mortality in sub-Saharan Africa: systematic review Trop Med Int Health 2010 15 5 508 519 10.1111/j.1365-3156.2010.02497.x 20345556 · DOI
  6. [10]Bintabara D Nakamura K Seino K Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey BMJ Open 2018 8 9 e023013 10.1136/bmjopen-2018-023013 30209158 PMC6144413 · DOI
  7. [14]Jong-Wook L Global health improvement and WHO: shaping the future Lancet 2003 362 9401 2083 2088 10.1016/S0140-6736(03)15107-0 14697812 PMC7133795 · DOI
  8. [15]Chancel L Hough A Voituriez T Reducing inequalities within countries: assessing the potential of the sustainable development goals Global Pol 2018 9 1 5 16 10.1111/1758-5899.12511 · DOI
  9. [16]Alvarez JL Gil R Hernández V Gil A Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study BMC Public Health 2009 9 1 1 8 10.1186/1471-2458-9-462 20003411 PMC2801510 · DOI
  10. [17]Badu E Gyamfi N Opoku MP Mprah WK Edusei AK Enablers and barriers in accessing sexual and reproductive health services among visually impaired women in the Ashanti and Brong Ahafo regions of Ghana Reprod Health Matters 2018 26 54 51 60 10.1080/09688080.2018.1538849 30465631 · DOI
  11. [18]Kea AZ Tulloch O Datiko DG Theobald S Kok MC Exploring barriers to the use of formal maternal health services and priority areas for action in Sidama zone, southern Ethiopia BMC Pregnancy Childbirth 2018 18 1 1 12 10.1186/s12884-018-1721-5 29649972 PMC5897996 · DOI
  12. [19]King R Jackson R Dietsch E Hailemariam A Barriers and facilitators to accessing skilled birth attendants in Afar region, Ethiopia Midwifery 2015 31 5 540 546 10.1016/j.midw.2015.02.004 25745841 · DOI
  13. [20]Okwaraji YB Webb EL Edmond KM Barriers in physical access to maternal health services in rural Ethiopia BMC Health Serv Res 2015 15 1 1 8 10.1186/s12913-015-1161-0 26537884 PMC4634737 · DOI
  14. [21]Geleto A Chojenta C Mussa A Loxton D Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa—a systematic review protocol Syst Rev 2018 7 1 60 10.1186/s13643-018-0720-y 29661217 PMC5902829 · DOI
  15. [22]Tamirat KS Tessema ZT Kebede FB Factors associated with the perceived barriers of health care access among reproductive-age women in Ethiopia: a secondary data analysis of 2016 Ethiopian demographic and health survey BMC Health Serv Res 2020 20 1 691 10.1186/s12913-020-05485-y 32711517 PMC7382096 · DOI
  16. [23]James A Jamison M Bleeding events and other complications during pregnancy and childbirth in women with von Willebrand disease J Thromb Haemost 2007 5 6 1165 1169 10.1111/j.1538-7836.2007.02563.x 17403089 · DOI
  17. [24]Mgawadere F Unkels R Kazembe A van den Broek N Factors associated with maternal mortality in Malawi: application of the three delays model BMC Pregnancy Childbirth 2017 17 1 1 9 10.1186/s12884-017-1406-5 28697794 PMC5506640 · DOI
  18. [25]Gausia K Ryder D Ali M Fisher C Moran A Koblinsky M Obstetric complications and psychological well-being: experiences of Bangladeshi women during pregnancy and childbirth J Health Popul Nutr 2012 30 2 172 10.3329/jhpn.v30i2.11310 22838159 PMC3397328 · DOI
  19. [26]Bertschy S Bostan C Meyer T Pannek J Medical complications during pregnancy and childbirth in women with SCI in Switzerland Spinal Cord 2016 54 3 183 187 10.1038/sc.2015.205 26620876 · DOI
  20. [28]Hosseinpoor AR Bergen N Magar V Monitoring inequality: an emerging priority for health post-2015 2015 Washington, DC SciELO Public Health PMC4581651 26478619
  21. [31]Filmer D Pritchett LH Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India Demography 2001 38 1 115 132 11227840
  22. [32]Vyass S Kumaranayake L Constructing socioeconomic status indexes: how to use principal component analysis Health Policy Plan 2006 21 6 459 468 10.1093/heapol/czl029 17030551 · DOI · Paper page
  23. [34]Wagstaff A The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality Health Econ 2005 14 4 429 432 10.1002/hec.953 15495147 · DOI
  24. [35]Erreygers G Correcting the concentration index J Health Econ 2009 28 2 504 515 10.1016/j.jhealeco.2008.02.003 18367273 · DOI
  25. [36]Wagstaff A Paci P Van Doorslaer E On the measurement of inequalities in health Soc Sci Med 1991 33 5 545 557 10.1016/0277-9536(91)90212-U 1962226 · DOI · Paper page
  26. [37]Wagstaff A Van Doorslaer E Watanabe N On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam J Econom 2003 112 1 207 223 10.1016/S0304-4076(02)00161-6 · DOI
  27. [38]Shifti DM Chojenta C Holliday EG Loxton D Socioeconomic inequality in short birth interval in Ethiopia: a decomposition analysis BMC Public Health 2020 20 1 1 13 10.1186/s12889-020-09537-0 33023567 PMC7542382 · DOI
  28. [39]Jain K Goli S Arokiasamy P Are self reported morbidities deceptive in measuring socio-economic inequalities Indian J Med Res 2012 136 5 750 23287121 PMC3573595
  29. [40]Adugna MB Nabbouh F Shehata S Ghahari S Barriers and facilitators to healthcare access for children with disabilities in low and middle income sub-Saharan African countries: a scoping review BMC Health Serv Res 2020 20 1 1 11 10.1186/s12913-019-4822-6 PMC6945633 31906927 · DOI
  30. [41]Ouedraogo NS Schimanski C Energy poverty in healthcare facilities: a “silent barrier” to improved healthcare in sub-Saharan Africa J Public Health Policy 2018 39 3 358 371 10.1057/s41271-018-0136-x 29950575 · DOI
  31. [42]Yaya S Wealth status, health insurance, and maternal health care utilization in Africa: evidence from Gabon BioMed Res Int 2020 2020 1 12 PMC7212326 32461984
  32. [43]Falkingham J Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan Soc Sci Med 2004 58 2 247 258 10.1016/S0277-9536(03)00008-X 14604611 · DOI
  33. [44]Murray S Poverty and health CMAJ 2006 174 7 923 10.1503/cmaj.060235 16567753 PMC1405857 · DOI
  34. [45]Abadi MY Relationship of knowledge, attitude, and perception of disease with the utilization of health services for non-convertive diseases in Rsud Haji Makassar Turk J Comput Math Educ (TURCOMAT) 2021 12 11 730 735 10.17762/turcomat.v12i11.5956 · DOI
  35. [46]Murray G Judd F Jackson H Fraser C Komiti A Hodgins G Rurality and mental health: the role of accessibility Aust N Z J Psychiatry 2004 38 8 629 634 10.1080/j.1440-1614.2004.01426.x 15298585 · DOI
  36. [47]Graves BA A model for assessment of potential geographical accessibility: a case for GIS Online J Rural Nurs Health Care 2009 9 1 46 55 10.14574/ojrnhc.v9i1.102 · DOI
  37. [48]Adedini SA Odimegwu C Bamiwuye O Fadeyibi O Wet ND Barriers to accessing health care in Nigeria: implications for child survival Glob Health Action 2014 7 1 23499 10.3402/gha.v7.23499 24647128 PMC3957799 · DOI
  38. [49]Tamirat KS Tessema ZT Kebede FB Factors associated with the perceived barriers of health care access among reproductive-age women in Ethiopia: a secondary data analysis of 2016 Ethiopian demographic and health survey BMC Health Serv Res 2020 20 1 1 8 10.1186/s12913-020-05485-y PMC7382096 32711517 · DOI
  39. [50]Berhan Y Berhan A Commentary: reasons for persistently high maternal and perinatal mortalities in Ethiopia: part III—perspective of the “three delays” model Ethiop J Health Sci 2014 24 137 148 10.4314/ejhs.v24i0.12S 25489188 PMC4249213 · DOI
  40. [51]Saxena D Vangani R Mavalankar D Thomsen S Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data Glob Health Action 2013 6 1 19652 10.3402/gha.v6i0.19652 PMC3591509 23469890 · DOI
  41. [52]Babalola S Fatusi A Determinants of use of maternal health services in Nigeria-looking beyond individual and household factors BMC Pregnancy Childbirth 2009 9 1 1 13 10.1186/1471-2393-9-43 19754941 PMC2754433 · DOI · Paper page
  42. [53]Wai KM Shibanuma A Oo NN Fillman TJ Saw YM Jimba M Are husbands involving in their spouses’ utilization of maternal care services?: A cross-sectional study in Yangon, Myanmar PLoS ONE 2015 10 12 e0144135 10.1371/journal.pone.0144135 26641891 PMC4671588 · DOI
  43. [54]Mullany BC Becker S Hindin M The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial Health Educ Res 2007 22 2 166 176 10.1093/her/cyl060 16855015 · DOI
  44. [55]Andersson P Leppert J Men of low socio-economic and educational level possess pronounced deficient knowledge about the risk factors related to coronary heart disease J Cardiovasc Risk 2001 8 6 371 377 10.1097/00043798-200112000-00006 11873093 · DOI
  45. [56]Ampt F Mon MM Than KK Khin MM Agius PA Morgan C Correlates of male involvement in maternal and newborn health: a cross-sectional study of men in a peri-urban region of Myanmar BMC Pregnancy Childbirth 2015 15 1 1 11 10.1186/s12884-015-0429-z 26013564 PMC4445797 · DOI
  46. [57]Birmeta K Dibaba Y Woldeyohannes D Determinants of maternal health care utilization in Holeta town, central Ethiopia BMC Health Serv Res 2013 13 1 1 10 10.1186/1472-6963-13-256 23822155 PMC3710264 · DOI
  47. [58]Abor PA Abekah-Nkrumah G Sakyi K Adjasi CK Abor J The socio-economic determinants of maternal health care utilization in Ghana Int J Soc Econ 2011 38 628 648 10.1108/03068291111139258 · DOI
  48. [60]Ononokpono DN Odimegwu CO Determinants of maternal health care utilization in Nigeria: a multilevel approach Pan Afric Med J 2014 17 Suppl 1 2 PMC3958146 24643545
  49. [61]Fatema K Lariscy JT Mass media exposure and maternal healthcare utilization in South Asia SSM-Popul Health. 2020 11 100614 10.1016/j.ssmph.2020.100614 32596437 PMC7306581 · DOI
  50. [62]Tamang TM, editor. Factors associated with completion of continuum of Care for Maternal Health in Nepal. In: IUSSP XXVIII International Population Conference, Cape Town, South Africa; 2017.

Cited by

Sorted by citations

Authors
Alamneh, T. S., Teshale, A. B., Yeshaw, Y., Alem, A. Z., Ayalew, H. G., Liyew, A. M., Tessema, Z. T., Tesema, G. A., & Worku, M. G.
Affiliations
  • University of Gondar (ET)
  • Wollo University (ET)
Corresponding author
Alamneh, Tesfa Sewunet
ORCID
Venue
BMC Women's Health
Publisher
Springer Science and Business Media LLC
Published
2022-04-25
Volume
22
Issue
1
Pages
130-130
ISSN
1472-6874 (ISSN-L)
DOI
10.1186/s12905-022-01716-y
PMC
PMC9036791
OpenAlex
W4224861402
Cited by
57
References
2
Citations by year
2026: 20 · 2025: 19 · 2024: 12 · 2023: 5 · 2022: 1
FWCI
6.78
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Women s Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Greater South Information System
Topics
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
  • Social Sciences › Health › Public Health and Social Inequalities
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
barriers to health care access, socioeconomic disparities, women of reproductive age, maternal health, maternal mortality, health equity, wealth index, women's education, husband education, mass media exposure, place of residence, sub-Saharan Africa
MeSH terms
Adult, Female, Health Services Accessibility, Humans, Marriage, Pregnancy, Socioeconomic Factors, Africa South of the Sahara, Health Status Disparities

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