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The Evolution of Socioeconomic-Related Inequalities in Maternal Healthcare Utilization: Evidence from Zimbabwe, 1994-2011

Makate, Marshall and Makate, Clifton (2016): The Evolution of Socioeconomic-Related Inequalities in Maternal Healthcare Utilization: Evidence from Zimbabwe, 1994-2011.

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Abstract

Abstract: Inequalities in maternal healthcare are pervasive in the developing world, a fact that has led to questions about the extent of these inequalities across socioeconomic groups. Yet, despite a growing literature on maternal health across Sub-Saharan African countries, relatively little is known about the evolution of these inequalities over time for specific countries. This study sought to examine and document the trends in the inequalities in prenatal care use, professional delivery assistance, and the receipt of information on pregnancy complications in Zimbabwe. We assess the extent to which the observed inequalities have been pro-poor or pro-rich. The empirical analysis uses data from four rounds of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 1994, 1999, 2005/06 and 2010/11. Three binary indicators were used as measures of maternal health care utilization; (1) the receipt of four or more antenatal care visits, (2) the use of professional delivery assistance, and (3) the receipt of information regarding pregnancy complications for the most recent pregnancy. We measure and explain inequalities in maternal health care use using Erreyger’s corrected concentration index. A decomposition analysis was conducted to determine the contributions of each determining factor to the measured inequalities. We found a significant and persistently pro-rich distribution of inequalities in professional delivery assistance and knowledge regarding pregnancy complications was observed between 1994 and 2010/11. Also, inequalities in prenatal care use were pro-rich in 1994, 2005/06 and 2010/11 periods and pro-poor in 1999. Furthermore, we stratified the results by rural or urban status. The results reveal a rising trend in observed inequalities in maternal health care use over time. Our findings suggest that addressing inequalities in maternal healthcare utilization requires coordinated public health policies targeting the more poor and vulnerable segments of the population in Zimbabwe.

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