|Birth in a Health Facility –Inequalities among the Ethiopian Women: Results from Repeated National Surveys|
||Elias Ali Yesuf, Mirkuzie Woldie Kerie, and Ronit Calderon-Margalit
||PLOS ONE , 9(4): e95439. doi:10.1371/journal.pone.0095439
||Background: Uptake of health facilities for delivery care in Ethiopia has not been examined in the light of equality. We
investigated differences in institutional deliveries by urbanity, administrative region, economic status and maternal
Methods: This study was based on nation-wide repeated surveys undertaken in the years 2000, 2005, and 2011. The surveys
used a cluster sampling design. Women of reproductive age were interviewed on the place of their last delivery. Data was
analyzed using logistic regressions to estimate the weighted association between birth in a health facility and study’s
Results: Utilization of health institutions for deliveries has improved throughout the study period, however, rates remain
low (5.4%,2000 and 11.8%,2011). Compared with women from rural places, women from urban areas had independent OR
of a health facility delivery of 4.9 (95% CI: 3.4, 7.0), 5.0 (95% CI: 3.6, 6.9), and 4.6 (95% CI: 3.5, 6.0) in 2000, 2005, and 2011,
respectively. Women with secondary/higher education had more deliveries in a healthcare facility than women with no
education, and these gaps widened over the years (OR: 35.1, 45.0 and 53.6 in 2000, 2005, and 2011, respectively). Women of
the upper economic quintile had 3.0–7.2 times the odds of healthcare facility deliveries, compared with the lowest quintile,
with no clear trend over the years. While Addis-Ababa and Dire Dawa remained with the highest OR for deliveries in a health
facility compared with Amhara, other regions displayed shifts in their relative ranking with Oromiya, SNNPR, Afar, Harari, and
Somali getting relatively worse over time.
Conclusions: The disparity related to urbanity or education in the use of health facility for birth in Ethiopia is staggering.
There is a small inequality between most regions except Addis Ababa/Dire Dawa and sign of abating inequity between
economic strata except for the richest households.