Inequalities in utilisation of maternal health services in Zimbabwe
Date
2018
Authors
Madzudzo, Nyasha
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Abstract
Background: Maternal mortality in developing countries like Zimbabwe is much higher amongst poorer, rural and less educated communities. Poorer or marginalised communities have the highest burden of disease and worst health status, but the least access to health care services. The distribution of health care resources and their use plays a key part in determining health and health outcomes. This study aims to measure inequalities in the utilisation of key maternal health care services in Zimbabwe using the PROGRESS-Plus framework, and to examine how the intersection of these factors create multidimensional advantage and disadvantage.
Methodology: Using Data from the 2015 Zimbabwe Demographic and Health Survey (DHS), the Concentration Index, Slope Index of inequality and Relative Index of Inequality were computed for key maternal health care utilisation outcomes. Bivariate and Multiple Logistic Regressions were computed to determine the PROGRESS-Plus factors associated with utilisation of these services. Multiple Correspondence Analysis was used to investigate the interaction of multiple PROGRESS- Plus factors influencing social position.
Results: The majority of women (93.3%) in the 2015 Zimbabwean DHS survey had a skilled ANC attendant although few of the women (38.5%) had their first ANC visit before four months gestation. Most women (78.1%) had a skilled birth attendant and delivered at a health facility (77.0%). Inequalities were higher in delivery care than antenatal care. The utilisation of maternal health service was higher amongst socially advantaged groups, although the magnitude of the inequality was small. Higher wealth index, educational attainment and health insurance coverage were significantly associated with higher maternal health service utilisation. These factors were closely inter-related with the same group of women having low wealth, low levels of education and no health insurance.
Conclusion: Inequalities in utilisation of maternal health services favour socially advantaged groups. Wealth, education and health insurance where the strongest determinants of use of maternal health care and these factors were interlinked. There is need to consider social protection policies that reduce the vulnerability of disadvantaged groups of women to access education and work opportunities
Keywords: Inequality, Maternal Health, Zimbabwe
Description
A research report submitted to the Faculty of Health Sciences,
University of the Witwatersrand, in fulfillment of the requirements for the degree of
Degree of Master of Public Health
Johannesburg, April 2018.